Robotic surgery of the infratemporal fossa utilizing novel suprahyoid port.
OBJECTIVE
To develop a minimally invasive technique for robotic access to the infratemporal fossa and describe use of a novel suprahyoid port placement.


METHODS
A cadaveric study to assess feasibility of robotic dissection of the infratemporal fossa using a novel, midline suprahyoid port placement.


METHODS
Six complete and two partial dissections of the infratemporal fossa were carried out on one fixed and three fresh cadaveric heads using the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA). The suprahyoid port site was utilized to place one robotic arm into the vallecula. The second arm and 30 degrees camera were placed transorally, and dissections were performed through the lateral pharyngeal wall and into the infratemporal fossa with identification and preservation of the lingual nerve, inferior alveolar nerve, internal and external carotid arteries, jugular vein, and cranial nerves IX-XII. Surgical clips were placed at the extent of dissection, and computed tomography (CT) imaging was obtained after dissections.


RESULTS
The transoral and midline suprahyoid port sites provide excellent access to the infratemporal fossa. The midline port site has excellent utility for accessing wide areas of the skull base bilaterally. CT imaging shows surgical clips placed successfully at the skull base foramina of major neurovascular structures.


CONCLUSIONS
Robotic surgery offers several advantages over traditional endoscopic surgery with the addition of tremor-free, two-handed technique and microscopic three-dimensional visualization. A midline suprahyoid port placement provides minimally invasive access for excellent exposure of the infratemporal fossa bilaterally.
McCool
Ryan R
RR
Division of Otolaryngology-Head and Neck Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
Warren
Frank M
FM
Wiggins
Richard H
RH
Hunt
Jason P
JP
D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D003391:Cranial Nerves / Q000473:pathology / Q000601:surgery; D004210:Dissection / Q000295:instrumentation; D006801:Humans; D006928:Hyoid Bone / Q000473:pathology / Q000601:surgery*; D007601:Jugular Veins / Q000473:pathology / Q000601:surgery; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D013525:Surgical Instruments; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*; D013996:Time and Motion Studies