title: Transoral robotic surgery of the skull base: a cadaver and feasibility study.
abstract: OBJECTIVE
  The goal of this study was to determine the potential role as well as the current limitations of the da Vinci Surgical System robot in transoral surgery of the skull base.
  
  
  METHODS
  The da Vinci robot was used to perform dissections of the skull base on 7 cadaver heads with their neck and clavicles intact. Neurosurgeons and otolaryngologists familiar with all facets of the open microscopic, minimally invasive, endoscopic and transoral robotic surgical procedure proceeded with the approach to and dissection of the human skull base.
  
  
  RESULTS
  The da Vinci robot provided superb illumination and 3-dimensional depth perception. The 30-degree endoscope improved cephalad visualization, and the 'intuitive' nature of the da Vinci surgical robot arms provided an advantage by their ability to suture the dura at the level of the clivus. An entirely transoral route provides access to the middle and lower clivus as well as the infratemporal fossa, but access to the sellar region and anterior cranial fossa is limited via a purely transoral route. Tremor-free dural closure was successfully performed.
  
  
  CONCLUSIONS
  Our findings suggest that transoral robotic surgery utilizing the da Vinci robot system holds great potential for skull base surgical resection of extradural and intradural tumors of the middle and lower clivus and infratemporal fossa. A collaborative approach with neurosurgeon and otolaryngologist alternating at the master console and bedside is a successful strategy. Further instrument development is necessary, and continued investigation is warranted.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA. leejohn@uphs.upenn.edu
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Bradley
authors.initials: B
authors.lastname: Lega
authors.forename: Jason
authors.initials: J
authors.lastname: Diaz
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
mesh_terms: D002102:Cadaver; D002493:Central Nervous System Diseases / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012371:Robotics / Q000295:instrumentation*; D019291:Skull Base / Q000601:surgery*