Robotic Surgery of Skull Base

Abstract

Czech novelist Karel Čapek introduced the word “robot” to the English language in his science fiction play Rossum’s Universal Robots (Rossumovi Univerzální Roboti) in 1920. Robotic systems in the field of medicine are remote performers that operate via the master-slave style. The only Food and Drug Administration (FDA)-approved surgical robotic system, the Da Vinci® (Intuitive Surgical International, CA), is designed to imitate the surgeons’ hand movements. The system consists of three major parts: the surgical console, the patient-side cart, and the vision cart. The surgical console is the remote part in which the surgeon operates seated by grasping the handpieces while viewing 3D images. The patient-side cart has three or four arms on which EndoWrist® instruments were installed that enable 7 degrees of motion performing surgeons’ hand commands. An endoscope is attached on one of these arms. The vision cart is equipped with a high-definition 3D endoscope and image-processing equipment. Although lagged behind the other surgical specialties, the use of robotics in otorhinolaryngology-head and neck surgery has recently gained a significant popularity. Studies by Hockstein, O’Malley, and Weinstein et al. revealed the usefulness of robotic surgery in the oropharynx, hypopharynx, and larynx. They pioneered the emergence of transoral robotic surgery (TORS), and after these leading studies, an FDA approval for TORS was gained for the benign diseases and T1 and T2 malignancies of head and neck in 2009. Recently, robot-assisted surgery is being intensively investigated and performed in all fields of otorhinolaryngology from thyroidectomy to cochlear implant insertion and from obstructive sleep apnea to skull base surgery and to other subspecialties.