Anatomical Considerations in Transoral Robotic Approach

Abstract

The complexity of head and neck robotic-assisted surgery is not the use of the robotic system itself, but in its application within tight anatomic confines and in the adjustment to new anatomic perspectives. These challenges are most applicable for transoral robotic surgery (TORS). Whereas abdominal robotic surgery can introduce trocars for the instruments and endoscopes at wide approach angles, TORS is confined to strict boundaries of the teeth and mandible. Even at the upper extent of mouth opening and retraction, the confinement creates challenges for instrument movement and endoscope positioning. The TORS surgeon therefore must always keep in mind the factors which can challenge or, at times, prevent a TORS approach. Anatomical considerations include trismus, tori, dentition, vasculature, and cervical spine. This chapter will review anatomic considerations of the TORS approach. With these factors taken into account, the TORS surgeon can progress to the performance of the specific surgical procedures which follow this chapter.