Robotic Instrumentation, Personnel, and Operating Room Setup

Robotic-assisted surgery (RAS) is becoming an increasingly important tool for certain diseases treated by the otolaryngologist and head and neck surgeon. As RAS expertise evolves and its use increases, many studies are underway to evaluate RAS as a replacement or alternative to established surgical techniques known to be invasive, potentially disfiguring, and sometimes devastating in terms of functional morbidity. Transoral robotic surgery (TORS) is the prime example of evolution within this surgical field for the management of primary or recurrent benign and malignant lesions of the pharynx and larynx, in particular the oropharynx and supraglottic larynx [1–4]. RAS has been rapidly integrated into the field due to a number factors, including (1) less morbid surgical access, (2) improved visualization, and (3) enhanced surgical precision in confined anatomic spaces [5–8]. It has also been championed for its cosmetic appeal, which allows for the avoidance of a conspicuous incision, such as for transaxillary thyroidectomy/parathyroidectomy or retroauricular neck dissection [9–11]. Moreover, RAS has been described for use in free tissue reconstruction as well as in the surgical management of sleep apnea [12–14]. The focus of this chapter is to provide general guidelines for operating room setup and communication, surgical instrumentation and equipment, and the necessary expertise of surgical personnel.