TORS used in skull base surgery was initially assessed by O’Malley Jr. and Weinstein [78], using animal and cadaver models. They also reported the first human case��a patient that underwent resection of parapharyngeal cystic neoplasm extending into the infratemporal fossa. Overall selleck chemical there were no adverse surgical events. Concern regarding identification of important structures, such as the carotid artery, jugular vein and cranial nerves was raised, and was solved by appropriate demonstration of surgical technique and hemostasis. In 2010, another study performed by O’Malley Jr. and Weinstein assessed the outcomes of 10 patients undergoing parapharyngeal space resection using the TORS approach. The surgery was performed in 9 of the 10 patients, with acceptable operative time and blood loss, and no significant complications such as hemorrhage, infection, trismus or tumor spillage.

One patient was converted to an open transcervical approach due to difficulties found during resection and to avoid the risk of tumor spillage. In 7 patients that had resection of a parapharyngeal space pleomorphic adenoma, local control was obtained in all 7 patients, although tumor spillage was reported in one patient. The TORS approach was found to offer reduced complication rates when compared to the transcervical approach [79, 80]. Another approach to the infratemporal fossa was developed by McCool et al. [81], in which 6 complete and 2 partial resections were performed using a suprahyoid port, while the other arms were placed transorally. In another report, Hanna et al.

[82] obtained excellent access to the anterior and central skull base in cadavers, including the cribriform plate, fovea ethmoidalis, medial orbits, planum sphenoidale, nasopharynx, pterygopalatine fossa, and clivus. In addition, sella turcica and suprasellar and parasellar access was achieved using the robotic arms. However, there is a continuing need for further development of appropriate instruments, in terms of size, flexibility, and function. 7.6. Pediatric Surgery Although there are studies of robotic surgery thyroidectomy in children [47, 48], which we have discussed previously, studies of robotic surgery in the pediatric population are sparse. To date, the only pediatric case series is that described by Rahbar et al. [83] in 2007 at Children’s Hospital Boston.

In this study, 4 pediatric cadaver larynxes were used to assess precision and tissue handling using a Batimastat robotic-system. 5 living patients were enrolled to undergo a laryngeal cleft repair. Equipment size was the main limiting factor for these procedures, resulting in limited transoral access in 3 of 5 the patients. The other 2 patients, who had type 1 and type 2 laryngeal clefts, had successful surgical repairs using the robotic system. 8.