Transoral robotic surgery of craniocervical junction and atlantoaxial spine: a cadaveric study.
OBJECTIVE
The goal of this study was to determine the potential role and current limitations of the da Vinci surgical robot in transoral decompression of craniocervical junction (CCJ).


METHODS
The da Vinci Surgical System was used in 2 cadaver heads with neck and clavicles intact. Both neurosurgeons and otolaryngologists familiar with the open microscopic procedure, as well as the transoral robotic surgical procedure, undertook dissection and decompression of the CCJ.


RESULTS
The robotic system provided superb illumination and 3D depth perception even several centimeters deep to the posterior oropharyngeal mucosa. The 30 degrees endoscope improved cephalad visualization, eliminating the need to split the soft palate for exposure of the lower clivus. The "intuitive" nature of the da Vinci surgical robot arms provided an advantage in allowing the ability to suture the dura mater in a deep, dark corridor. Because visualization was excellent, tremor-free closure was possible.


CONCLUSIONS
The authors' findings suggest that transoral robotic surgery, with the da Vinci robot system, holds great potential for decompression of the CCJ as well as resection of both extra- and intradural tumors of this region. Further instrument development is necessary and continued investigation is warranted.
Lee
John Y K
JY
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. leejohn@uphs.upenn.edu
O'Malley
Bert W
BW
Newman
Jason G
JG
Weinstein
Gregory S
GS
Lega
Bradley
B
Diaz
Jason
J
Grady
M Sean
MS
D001268:Atlanto-Axial Joint / Q000473:pathology / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004210:Dissection / Q000295:instrumentation; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D019723:Endoscopes; D004867:Equipment Design; D006804:Ergonomics; D006801:Humans; D021621:Imaging, Three-Dimensional; D009809:Odontoid Process / Q000473:pathology / Q000601:surgery; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments