title: Robotic nasopharyngectomy via combined endonasal and transantral port: a preliminary cadaveric study.
abstract: OBJECTIVE
  The objective of this study was to determine the potential role of a surgical robotic system in nasopharyngeal surgery using bilateral transantral or combined endonasal/transantral port.
  
  
  METHODS
  The da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA) was used to perform dissection of the skull base on a whole fresh-frozen cadaver.
  
  
  METHODS
  Bilateral mega-antrostomy was done with the usual endoscopic sinus surgery equipment. To obtain an accessible bilateral working space, posterior septectomy was performed. Next, bilateral anterior maxillary windows were created through a gingivobuccal incision. The 8.5-mm-diameter 0° or 30° three-dimensional camera arm was introduced into a nostril. The two 5-mm-diameter articulating EndoWrist arms entered through the transantral or endonasal port. For the dissection, Maryland articulated forceps, needle driver, and monopolar spatula- or hook-type electrocauterizer were used.
  
  
  RESULTS
  The 8.5-mm diameter of the camera arm was easily inserted into the nostril. Excellent access to the nasopharyngeal area from the level of the palate up to the skull base crossing the sphenoid prow was possible. Bilateral robotic arms were able to move inside the nasopharyngeal space, and the target dissection area could be accessed fully via the transantral or endonasal port.
  
  
  CONCLUSIONS
  This is the first report about the feasibility of bilateral transantral or combined transantral/endonasal port for robotic nasopharyngectomy. Robotic removal of the entire nasopharyngeal area was successfully achieved without transpalatal or facial skin incision. These new approaches may be applied to selected patients with nasopharyngeal carcinoma or other pathologic tumors involving the nasopharynx.
  
  
  METHODS
  NA
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.|Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyung-Ju
authors: HJ
authors: Cho
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Ju Wan
authors: JW
authors: Kang
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyun Jin
authors: HJ
authors: Min
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyo Jin
authors: HJ
authors: Chung
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Do Yang
authors: DY
authors: Park
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Jong Gyun
authors: JG
authors: Ha
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Seung Hak
authors: SH
authors: Baek
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.|Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Joo-Heon
authors: JH
authors: Yoon
authors: Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.|Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Chang-Hoon
authors: CH
authors: Kim
mesh_terms: D002102:Cadaver; D004867:Equipment Design; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009055:Mouth; D009296:Nasal Cavity; D009305:Nasopharynx / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009666:Nose; D015203:Reproducibility of Results; D012371:Robotics / Q000295:instrumentation*
keywords: Robot; endoscope; nasopharyngeal carcinoma; nasopharynx