Applications of transoral, transcervical, transnasal, and transpalatal corridors for Robotic surgery of the skull base

Endoscopic endonasal approaches (EEAs) provide an alternative surgical corridor to treat benign and malignant lesions of the sinonasal tract and skull base. According to the extent of the lesion and the surgical team experience, an endoscopic endonasal skull base approach can provide exposure of vital neurovascular structures and enable the surgeon to resect the lesion safely and completely. Similarly, robotic-assisted surgery facilitates the performance of highly complex surgeries in areas of the upper aerodigestive tract that are relatively difficult to access or to manipulate instruments, such as the oral cavity, nasopharynx, oropharynx or hypopharynx, supraglottis, glottis, parapharyngeal space and infratemporal fossa (ITF). Operative time and time of hospitalization are superior to those associated with open approaches and are associated with less morbidity. Various feasibility studies have suggested that robotic-assisted surgery may be applied to skull base surgery with similar results. In general, skull base surgery is difficult and complex due to its anatomical intricacies, deep-seated nature, and the presence of adjacent vital structures. In addition, the relative rarity of indications increases the difficulty for a surgeon to become familiar with the detailed anatomy and the various pathologies affecting the region. This study was undertaken to better define and understand the potential use and limitations of current robotic approaches to the skull base.