Transoral robotic surgery to resect skull base tumors via transpalatal and lateral pharyngeal approaches

Abstract

Robot-assisted surgery in the field of head and neck has been gaining popularity due to appeal in using minimally invasive approaches, obtaining excellent visualization, and overall low risk. Reports among multiple different specialties have also shown reduction in surgery duration, recovery time in the intensive care unit, and overall time of hospitalization stays when compared to classic open procedures [1]. Techniques for resecting skull base cancers are traditionally performed through large incisions and require mobilization of large amounts of tissue. Transoral robotic surgery (TORS) may provide a more accurate means to treat head and neck and skull base cancer, while allowing for decreased levels of morbidity and decreased levels of adjuvant radiation and chemotherapy. Reports on the development of TORS application to anterior skull base masses have previously described in small case descriptions in preclinical experimental canine and cadaver models using transcervical or suprahyoid ports [2–4]. Subsequently, TORS was applied to a small case series and feasible in 9 of 10 patients with parapharyngeal space tumors with no carotid encasement or bone erosion [5]. The objective of this study is to discuss feasible approaches using transoral robotic surgery (TORS) to access the anterior and lateral skull base and describe a novel approach for nodal dissection in the retropharyngeal space.