Robotic anterior and midline skull base surgery: preclinical investigations.
OBJECTIVE
To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation.


METHODS
Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed.


RESULTS
Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base.


CONCLUSIONS
Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development.
O'Malley
Bert W
BW
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA. bert.omalley@uphs.upenn.edu
Weinstein
Gregory S
GS
D000818:Animals; D004285:Dogs; D006801:Humans; D012371:Robotics / Q000379:methods*; D019292:Skull Base Neoplasms / Q000601:surgery*