Endoscopic Skull Base Surgery Indications Continue to Expand

“With open skull base surgery, you are able to use two hands or more with assistants in the operating room,” he said. “You also have top-down visualization and relatively prompt control of any bleeding. This is not readily possible with present endoscopic skull base surgery approaches and techniques.”

Robotic-assisted skull base surgery, on the other hand, provides manual dexterity equal to or better than open surgery, while working through small openings in the oral cavity and soon through the nose as the robotic instruments continue to be miniaturized, explained Dr. O’Malley.

Moreover, the robot has four arms that one person operates, he explained. “It provides amazing three-dimensional visualization, bimanual and even trimanual dexterity, fine instrument mobility, and overall precise dissection,” he said.

While beneficial, the robotic itself and associated instruments are expensive, and as with any technology, there is the possibility of mechanical failures, said Dr. O’Malley. There is also a learning curve involved with using the robot; however, Dr. O’Malley and Dr. Weinstein believe that this curve is much easier than that needed to learn other transoral and endoscopic skull base surgical techniques.

The most apparent limitation of the robot in skull base surgery or even standard endoscopic sinus surgery is that current instrumentation is not designed for endoscopic or transoral minimally invasive skull base surgery, said Dr. O’Malley. “We’re working hard to adapt it for skull base surgery,” he explained.

Dr. O’Malley and Dr. Weinstein, in addition to the early adopter surgeons whom they have trained over the past year, are hoping to introduce much smaller instrumentation in the near future, which should enable more widespread use in skull base surgery.

How soon such technology is available depends on funding from medical device companies, said Dr. O’Malley. “It could take six months to six years,” he said. “Overall, I strongly feel that this is the wave of the future for head and neck and sinus and skull base surgical procedures,” he concluded.

©2007 The Triological Society