Ricardo L Carrau1, Daniel M Prevedello, Danielle de Lara, Kasim Durmus, Enver Ozer. 1. 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.
Abstract
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.
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.
Authors: Julia Kristin; Armin Kolmer; Peter Kraus; Robert Geiger; Thomas Klenzner Journal: Eur Arch Otorhinolaryngol Date: 2014-04-24 Impact factor: 2.503
Authors: Kangsadarn Tanjararak; Smita Upadhyay; Thanakorn Thiensri; Jun Muto; Boonsam Roongpuvapaht; Daniel M Prevedello; Ricardo L Carrau Journal: J Neurol Surg B Skull Base Date: 2017-10-13