title: Robotic surgery for the sinuses and skull base:  what are the possibilities and what are the obstacles?
abstract: OBJECTIVE
  Robotic surgery in otolaryngology - head and neck surgery has become a valuable tool in certain anatomic approaches; however, its application in surgery of the paranasal sinuses and anterior skull base is still in an investigatory phase and requires further evaluation.
  
  
  RESULTS
  Existing robotic surgical systems face particular limitations in their application at the skull base because of instrument size and lack of variability. Unfortunately, only one system is available commercially that is applicable in the head and neck region and FDA approved for use in patients. This system, although advantageous in many otolaryngologic procedures, is difficult to use for endoscopic sinus and skull base surgery. However, other systems that target this anatomic subsite specifically are in development and show promise. Advances in the design of robotic arms, materials, and shape will potentially give surgeons a significant advantage over traditional endoscopic techniques.
  
  
  CONCLUSIONS
  This article will review the current applications of robotic systems in paranasal sinus and skull base surgery, describe the requirements of a robotic system for use in this type of surgery, and describe a system under development at our institution.
authors.affiliation: Department of Otolaryngology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee 37232-8605, USA. john.s.schneider@vanderbilt.edu
authors.forename: John S
authors.initials: JS
authors.lastname: Schneider
authors.forename: Jessica
authors.initials: J
authors.lastname: Burgner
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Webster
authors.forename: Paul T
authors.initials: PT
authors.lastname: Russell
mesh_terms: D004724:Endoscopy / Q000379:methods; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D012371:Robotics; D019291:Skull Base / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*