title: Robotic skull base surgery via supraorbital keyhole approach: a cadaveric study.
abstract: BACKGROUND
  The supraorbital keyhole approach has been used in anterior skull base tumor and aneurysm surgery. However, there are debates regarding the safety and limitations of this kind of approach.
  
  
  OBJECTIVE
  To determine the feasibility and potential benefits of surgical robotic technology in minimally invasive neurosurgery.
  
  
  METHODS
  Two fresh cadaver heads were studied with the da Vinci Surgical System with 0° and 30° stereoscopic endoscopes to visualize neuroanatomy. The ability of the system to suture and place clips under the keyhole approach was tested.
  
  
  RESULTS
  The da Vinci Surgical System was used throughout the supraorbital transeyebrow keyhole approach. With the use of standard microdissection techniques, the optic nerve, optic chiasm, carotid artery, and third cranial nerve were visualized. The sylvian fissure was then exposed from the proximal sylvian membrane to the distal M1 segment. With the EndoWrist microforceps, suturing can be achieved smoothly to close a defect created on the M2 artery. Although the benefits in adjusting clips during aneurysm surgery could be provided by an articulating applier, a proper robotic applier is not currently available.
  
  
  CONCLUSIONS
  The minimally invasive supraorbital keyhole surgery can be achieved with the da Vinci Surgical System in cadaver models. This system provides neurosurgeons with broader vision and articulable instruments, which standard microsurgical systems do not provide. Further studies are necessary to evaluate the safety and benefits of using the da Vinci Surgical System in minimally invasive neurosurgery.
authors.affiliation: Institute of Biomedical Engineering, Department of Surgery, National Taiwan University, Taipei, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Hong
authors.forename: Jui-Chang
authors.initials: JC
authors.lastname: Tsai
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Sorger
mesh_terms: D001099:Arachnoid / Q000033:anatomy & histology / Q000601:surgery; D002102:Cadaver; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D005138:Eyebrows / Q000033:anatomy & histology; D005240:Feasibility Studies; D006257:Head; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D009802:Oculomotor Nerve / Q000033:anatomy & histology / Q000601:surgery; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D012658:Sella Turcica / Q000033:anatomy & histology / Q000601:surgery; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*