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. 2013 Dec;149(6):940-6.
doi: 10.1177/0194599813509587. Epub 2013 Oct 23.

Multiportal robotic access to the anterior cranial fossa: a surgical and engineering feasibility study

Randall A Bly  1 , David Su, Thomas S Lendvay, Diana Friedman, Blake Hannaford, Manuel Ferreira, Kris S Moe
Affiliations

Multiportal robotic access to the anterior cranial fossa: a surgical and engineering feasibility study

Randall A Bly et al. Otolaryngol Head Neck Surg. 2013 Dec.

Abstract

Objective: Integration of robotic surgical technology into skull base surgery is limited due to minimum angle requirements between robotic tools (narrow funnel effect), steep angle of approach, and instrumentation size. The objectives of this study were to systematically analyze surgical approach portals using a computer model, determine optimal approaches, and assess feasibility of the derived approaches on robotic surgical systems.

Study design: Computer analysis on 10 computed tomography scans was performed to determine approach trajectories, angles between robotic tools, and distances to specified skull base target locations for transorbital and transnasal surgical approach portals.

Setting: Dry laboratory and cadaver laboratory.

Subjects and methods: The optimal combinations were tested on the da Vinci and Raven robotic systems.

Results: Multiportal analyses showed the angles between 2 robotic tools were 14.7, 28.3, and 52.0 degrees in the cases of 2 transnasal portals, combined transnasal and medial orbit portals, and bilateral superior orbit portals, respectively, approaching a prechiasmatic target. The addition of medial and superior transorbital portals improved the skull base trajectory angles 21 and 27 degrees, respectively. Two robotic tools required an angle of at least 20 degrees between them to function effectively at skull base targets.

Conclusion: Technical feasibility of robotic transorbital and transnasal approaches to access sella and parasellar target locations was demonstrated. This technique addresses the 2 major drawbacks of (1) the narrow funnel effect generated from portals in close proximity and (2) the steep angle of approach to the skull base, as observed in previous studies analyzing transoral, transcervical, transmaxillary, and transhyoid portals.

Keywords: endoscopic; pituitary; robotic surgery; skull base; transorbital.

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Conflict of interest statement

Competing interests: Kris S. Moe is a founder and shareholder for SPI Surgical, Inc.

Figures

Figure 1
Figure 1
Screenshot of the graphical user interface of the iNtellect Cranial Navigation (Stryker Corporation, Kalamazoo, Michigan) used to visualize approach trajectories and collect (x,y,z) coordinate data. In the lower right quadrant, skull base and sagittal planes are depicted.
Figure 2
Figure 2
da Vinci robotic system applied to a dry skull to assess gross geometric feasibility. Range in angulation between robotic arms was 26 to 46 degrees.
Figure 3
Figure 3
Modeled (red clay) pituitary targets accessed by transorbital da Vinci robotic instruments. (A) Transnasal endoscope, instruments transorbital, and (B) left medial orbit endoscope, instruments through contralateral medial orbital and transnasal portals. Video available online at otojournal.org.
Figure 4
Figure 4
Multiportal technique with the Raven robot. The endoscope was placed transnasally and robotic tools were placed through bilateral medial orbit portals to access the anterior cranial fossa.
Figure 5
Figure 5
Robotic instruments accessing the prechiasmatic target location.
Figure 6
Figure 6
Raven surgical robotic system tool range of motion (18–40 degrees) in bilateral medial orbit portals to access sella and parasellar target locations.
See this image and copyright information in PMC

References

    1. Hanna EY, Holsinger C, DeMonte F, Kupferman M. Robotic endoscopic surgery of the skull base: a novel surgical approach. Arch Otolaryngol Head Neck Surg. 2007;133:1209–1214. - PubMed
    1. McCool RR, Warren FM, Wiggins RH, III, Hunt JP. Robotic surgery of the infratemporal fossa utilizing novel suprahyoid port. Laryngoscope. 2010;120:1738–1743. - PubMed
    1. O’Malley BW, Weinstein GS. Robotic anterior and midline skull base surgery: preclinical investigations. Int J Radiat Oncol Biol Phys. 2007;69(suppl 2):S125–S128. - PubMed
    1. Lee JY, O’Malley BW, Jr, Newman JG, et al. Transoral robotic surgery of the skull base: a cadaver and feasibility study. ORL J Otorhinolaryngol Relat Spec. 2010;72:181–187. - PubMed
    1. Kupferman M, Demonte F, Holsinger FC, et al. Transantral robotic access to the pituitary gland. Otolaryngol Head Neck Surg. 2009;141:413–415. - PubMed

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