Robotic Surgery Offers Advantages for Infratemporal Fossa

Does robotic surgery provide better access to the infratemporal fossa (ITF), and is suprahyoid port placement an option? 

Background: Recent experimentation with robotic-assisted surgery has shown applications in head and neck surgery and advantages such as excellent three-dimensional microscopic visualization and two-handed, tremor-free operating. These advantages make robotic surgery particularly attractive in areas in which open approaches are technically difficult or functionally morbid, such as ITF.

Study design: Cadaveric studies

Setting: Division of Otolaryngology-Head and Neck Surgery and Department of Neuroradiology, University of Utah Health Sciences Center, Salt Lake City

Synopsis: Using one fixed and three fresh cadaver heads, surgeons performed six complete and two partial bilateral dissections of the ITF using the da Vinci surgical robot. The suprahyoid port side was utilized to place one robotic arm into the vallecula; the second arm and 30-degree camera were placed transorally. Setup times and operative times decreased significantly with increased familiarity with the system. The 30-degree three-dimensional endoscope used during dissections provided excellent visualization into the ITF, and the equipment provided ease of dissection. Computed tomography (CT) imaging after dissections provided evidence of the extent of the dissection, while photographs provided evidence of improved visualization.

Noting that the potential consequences of lateral transcervical port placement are significant, the authors said there is risk of damaging structures. The midline suprahyoid port placement they used “is both novel and highly effective for dissection of wide areas of the skull base bilaterally,” they said, adding that “the suprahyoid port placement is less invasive than a Sistrunk procedure” and has fewer complications.

Bottom line: Use of robotic surgery at the skull base has promising advantages over current open and endoscopic techniques, and the suprahyoid port placement is effective for accessing a wide area of the skull bilaterally.

Citation: McCool RR, Warren FM, Wiggins RH, et al. Robotic surgery of the infratemporal fossa utilizing novel suprahyoid port. Laryngoscope. 2010;120(9):1738-1743.

—Reviewed by Sue Pondrom