Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series

Feasibility of Robotic Transorbital Surgery

BACKGROUND AND OBJECTIVES

The transorbital approach (TOA) facilitates access to pathologies lateral to the optic nerve, a region that is difficult to access with an endonasal approach. In this study, we sought to investigate the feasibility of robotic-assisted surgery in lateral TOA.

METHODS

Six colored-silicon-injected human postmortem heads were prepared for dissection. The DaVinci Xi model was used with a 0-degree camera, 8 mm in diameter. A black diamond microforceps with an 8-mm diameter and 10-mm jaw length was used. The entry point of V1 (superior orbital fissure), V3 (foramen ovale), and posterior root of the trigeminal ganglion were chosen as the surgical targets. The length from the entry opening to each target point was measured. The angles formed between pairs of target points were measured to obtain the horizontal angle (root of the trigeminal ganglion-entry-V1) and the vertical angle (root of the trigeminal ganglion-entry-V3).

RESULTS

Dissection was performed on 12 sides (6 specimens). The median distance from the entry point was 55 mm (range 50-58 mm) to the entry point of V1 (superior orbital fissure), 65 mm (range 57-70 mm) to the entry point of V3 (foramen ovale), and 76 mm (range 70-87 mm) to the root of the trigeminal ganglion. Meanwhile, the median of surgical angle between the entry point and the target was 19.1° (range 11.8-30.4°) on the horizontal angle and 16.5° (range 6.2-21.6°) on the vertical angle.

CONCLUSION

This study found that application of lateral TOA in robotic-assisted surgery is premature because of the large size of the tool. However, although the entrance in lateral TOA is narrow, the internal surgical space is wide; this offers potential for design of appropriate surgical tools to allow increase tool usage.

History, Current Techniques, and Future Prospects of Surgery to the Sellar and Parasellar Region

The sellar and parasellar region can be affected by diverse pathologies. The deep-seated location and surrounding critical neurovascular structures make treatment challenging; there is no singular, optimal approach for management. The history and development of transcranial and transsphenoidal approaches by pioneers in skull base surgery were largely aimed at treating pituitary adenomas, which are the most common lesions of the sella. This review explores the history of sellar surgery, the most commonly used approaches today, and future considerations for surgery of the sellar/parasellar region.