| Summary: | Virtual reality (VR) simulation and robotic surgery represent two focus areas for research and development in Otolaryngology-Head & Neck Surgery. This thesis was driven by a desire to deliver improvements in surgical training and patient care. The development and long-term prospective clinical evaluation of three novel robotic applications in Head & Neck surgery were investigated. The results suggest that robotic assisted thyroidectomy and robotic assisted parathyroidectomy are safe, feasible alternatives to conventional surgery. The primary advantage is the avoidance of a neck scar. The approach occupies a niche role that is justified in patients who have cultural or biological drivers to avoid a neck scar. Improvement in surgical exposure was necessary. A novel soft-tissue retractor was designed and manufactured to address this issue. Transoral robotic surgery represents a promising treatment option for patients with obstructive sleep apnoea who cannot tolerate or fail all the other treatment modalities. Biometric measures represent an important tool when assessing patient suitability for TORS. Only those who have undergone appropriate training, proctoring and licensure should perform robotic surgery. Safe implementation is essential. The studies of VR temporal bone simulation served as a preparatory to introducing VR simulation for robotic head and neck surgery. The face, content and construct validation of a novel temporal bone simulator was demonstrated. Further studies were conducted to benchmark and pilot a VR skills curriculum and assess the role of case specific surgical rehearsal. Simulation training represented a useful adjunct. This body work demonstrates that both technologies can be integrated to deliver effective robotic surgical training to enhance surgical performance and improve patient care.
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