Experimental Approaches and Future Applications of Robotic Surgery in the Head and Neck

Abstract

Robotic surgery in the head and neck has developed rapidly in the past 10 years, particularly after the Da Vinci robot by Intuitive Surgical received FDA approval in 2009 for applications in the head and neck. Currently, applications have been primarily focused on transoral robotic surgery (TORS) and minimally invasive thyroid surgery. However, the three-dimensional view provided by the robotic camera, the advanced wrist rotation and flexibility, and ability to approach areas that previously required large open incisions have created a paradigm shift setting the stage for exploration into innovative approaches in the head and neck. From congential cysts to salivary gland tumors to neck dissection, more minimally invasive techniques are being continually studied, developed, and published.

The use of robotic assistance for surgery of the paranasal sinuses and skull base is a new frontier in the capabilities of the surgical robotics. These areas typically have limited access for open surgery except with invasive and morbid external approaches. Minimally invasive endoscopic approaches have become the standard of care in paranasal sinus surgery and the forefront of research in skull base surgery. A natural extension of the endoscopic approach in areas of limited access is the surgical robot, which can augment the endoscopic view with three-dimensional depth perception, multiple wristed arms, and precision instrument control. The limitations of robotic surgery of the paranasal sinuses and skull base stem from the constraints of accessing these areas through the nose, mouth, or neck. In this chapter we will discuss the research that has been published in the area of robotic approaches to the sinuses and skull base, as well as future applications and directions of research.