Robotic surgery of the anterior skull base

Abstract

Background: Significant advances have been made in transoral robotic surgery (TORS), yet its application in anterior skull-base surgery has yet to be defined. This work explores the history of endoscopic sinus and anterior skullbase surgery, and its advantages and disadvantages. The development of robotic surgery is then discussed as well as the advantages and disadvantages of TORS as it relates to the anterior skull base. The current applications for robotic surgery to the anterior skull base are presented with details of future applications. Methods:A structured search of the current literature using MEDLINE, PubMed, and EMBASE was performed from inception to May 2019. Search terms related to topics of robotic skull-base surgery were identified and queried to identify relevant articles. Results:Fi y-four papers were identified from the literature search and a hand search of the references. Twentyone other references were discovered from personal communication, websites, and books relevant to the topic. Conclusion:Anterior skull-base surgery has the potential for significant morbidity compared to head and neck surgery, yet the application of the robot in sinus and anterior skull-base surgery has yet to be formally defined. Currently, there are certain limitations that need to be overcome; however, research to address these barriers is currently underway and promises an exciting future for robotic sinus and anterior skull-base surgery. C 2019 ARS-AAOA, LLC.

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“…Implementation of the prototype in a clinical setting requires engineering effort and high investment, which has been a hindrance to its usage [23,24]. However, robotic surgery in skull base drilling would have been beneficial as well as in endoscopic guiding systems [25]. Methods such as the 4-hand technique, which is part of the implementation for the skull base surgery routine, could also be used with the endoscopic guiding systems [21].…”

The Current State of Visualization Techniques in Endoscopic Skull Base Surgery

“…Nevertheless, systems such as the da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA, USA), have been investigated in skull base surgery [ 34 , 35 ]. The incorporation of robotics has the potential to address the limitations of endoscopy—2D monocular vision, often requiring two co-surgeons—by providing 3D HD vision, requiring one surgeon, reducing the effects of physiological tremor, and increasing dexterity [ 36 ]. Robotic systems in conjunction with ESBS have been demonstrated to be feasible [ 37 ].…”

Quality of life after endoscopic skull base surgery with a nasoseptal flap: a systematic review

“…Significant progress has been made in the treatment of anterior skull base lesions, ranging from endoscopic visualisation of pituitary macroadenomas 1 to utilisation of robotic surgery. 2…”

“…Significant progress has been made in the treatment of anterior skull base lesions, ranging from endoscopic visualisation of pituitary macroadenomas 1 to utilisation of robotic surgery. 2 The use of vascularised nasoseptal flaps has recently become many institutions' primary endoscopic reconstructive technique after endoscopic skull base surgery. It reduces the risk of post-operative cerebrospinal fluid (CSF) leak after reconstruction, 3 and can be useful even for difficult-to-treat CSF leaks.…”