Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base
Corresponding Author
Ricardo L. Carrau MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Conflict of interest: Drs. Carrau and Prevedello have been sponsored by Storz Endoscopy to travel to international courses (as faculty).
Director of Skull Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Medical Center, 456 West 10th Avenue, Cramblett Hall, Suite 4A, Columbus, OH 43210-1282 E-mail: [email protected].Search for more papers by this authorDaniel M. Prevedello MD
Department of Neurological Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorDanielle de Lara MD
Department of Neurological Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorKasim Durmus MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorEnver Ozer MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorCorresponding Author
Ricardo L. Carrau MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Conflict of interest: Drs. Carrau and Prevedello have been sponsored by Storz Endoscopy to travel to international courses (as faculty).
Director of Skull Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Medical Center, 456 West 10th Avenue, Cramblett Hall, Suite 4A, Columbus, OH 43210-1282 E-mail: [email protected].Search for more papers by this authorDaniel M. Prevedello MD
Department of Neurological Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorDanielle de Lara MD
Department of Neurological Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorKasim Durmus MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorEnver Ozer MD
Department of Otolaryngology – Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
Search for more papers by this authorAbstract
Background
Oncologic resection of the clivus, nasopharynx, craniovertebral junction, and infratemporal fossa is a challenging endeavor because of their complex and protected anatomy. Our goals were to design a cadaveric model and identify advantages and limitations of combining the transoral robotic surgery (TORS) and endoscopic endonasal approach (EEA) techniques.
Methods
Cadaveric specimens were dissected using a da Vinci surgical robot and endoscopic endonasal instruments in a fashion that mimicked our operating room environment. We then applied these techniques clinically.
Results
EEA was performed to provide a detailed dissection of the infratemporal fossa, nasopharynx, posterior skull base (clivus), and craniovertebral junction. Using TORS, we dissected the parapharyngeal space, infratemporal fossa, and nasopharynx below the eustachian tube, which represented a transition zone that delineated the most effective resection field of each approach.
Conclusions
TORS and EEA seem to be complementary techniques; thus, their combined use seems advantageous for selected advanced tumors in these complex areas. © 2013 Wiley Periodicals, Inc. Head Neck, 35: E351–E358, 2013
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