Robot-Assisted Surgery Around the Nose

Abstract

Owing to improvements in endonasal endoscopic approaches and technologies, as well as in computerized tomography, these regions have now been fully exposed and mastered. Establishing the correct pathophysiology is important for diagnosis and treatment. Technological improvements have allowed for the development of more effective, easier-to-apply, and less invasive surgical modalities. For example, improvements in endonasal endoscopy have allowed us to understand the physiopathology of inflammatory conditions, such as rhinosinusitis, and have precipitated a change in approach to such diseases, finally resulting in the development of functional endoscopic sinus surgery. Recently, advanced endoscopic surgical techniques have emerged for orbital and cerebrospinal fluid (CSF) fistula repair. Endoscopic navigation is also considered to be a highly facilitative technology. Both malignant and benign lesions in the sinonasal region have been treated successfully using newly developed instruments. Recently, the skull base, infratemporal fossa, and petrous apex have all been managed endoscopically. In terms of the advantages of surgical robots with respect to overcoming the limitations of endoscopic endonasal surgery, the Da Vinci system provides a high-definition 3D view with ×16 magnification. Transorally, or through very small skin incisions, minimally invasive surgery can be performed. Tremor-filtering robotic instruments, while mimicking hand wrist motion, have the capacity for 540° movement in seven planes. During robotic surgery, the console surgeon can control the instruments with both hands, and the patient cart can be used for aspiration and to manipulate retractors to achieve exposure. Additionally, sutures can be applied with two hands and surgical instruments can be left in the surgical field. These advantages allow for safer, easier, and more ergonomic surgery.