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Muto J, Tateya I, Nakatomi H, Uyama I, Hirose Y. Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions. Neurospine 2024; 21:106-115. [PMID: 38569637 PMCID: PMC10992650 DOI: 10.14245/ns.2448062.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine. METHODS In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal. RESULTS Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach. CONCLUSION This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.
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Affiliation(s)
- Jun Muto
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Fujita Health University, Aichi, Japan
| | | | - Ichiro Uyama
- Department of General Surgery, Fujita Health University, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
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Wieker H, Hinrichs C, Retzlaff M, Spille JH, Laudien M, Acil Y, Wiltfang J, Gülses A. A technical feasibility study on adaptation of a microsurgical robotic system to an intraoperative complication management in dental implantology: perforated Schneiderian membrane repair using Symani ® Surgical System. J Robot Surg 2023; 17:2861-2867. [PMID: 37803127 PMCID: PMC10678809 DOI: 10.1007/s11701-023-01721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Abstract
The aim of the current study was to test the technical and clinical feasibility of a robotic system and investigate its potential in the surgical repair of perforated Schneiderian membranes using an ex-vivo porcine model. Eight pig heads were operated conventionally via a surgical loop and eight pig heads with the surgical robot "Symani® Surgical System" (Medical Microinstruments, Inc., Pisa, Italy). On each specimen, the Schneiderian membrane was incised over a length of 0.7 mm resembling a perforation. Operation time, the maximum sinusoidal pressure, the course of the pressure and the filling volume were measured. Additionally, adaptation of the wound edges has been detected via scanning electron microscopy. There were no significant differences for the pressure maximum (p = 0.528), for the time until the pressure maximum was reached (p = 0.528), or for the maximum filling volume (p = 0.674). The time needed for the suturing of the membrane via robotic surgery was significantly longer (p < 0.001). However, the scanning electron microscope revealed a better adaptation of the wound edges with robotic surgery. The technical feasibility of robot-assisted suturing of Schneiderian membrane laceration using the robotic system has been confirmed for the first time. No differences considering the pressure resistance compared to the conventional repair could be observed, but advantages in wound adaptation could be found with an electron microscope. Regarding the material and training costs and limited indications spectrum, robotic surgery systems still might not present financially feasible options in the daily dental practice yet.
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Affiliation(s)
- Henning Wieker
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Cedric Hinrichs
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Merle Retzlaff
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Johannes Heinrich Spille
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Martin Laudien
- Department of ENT Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany.
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Pangal DJ, Cote DJ, Ruzevick J, Yarovinsky B, Kugener G, Wrobel B, Ference EH, Swanson M, Hung AJ, Donoho DA, Giannotta S, Zada G. Robotic and robot-assisted skull base neurosurgery: systematic review of current applications and future directions. Neurosurg Focus 2022; 52:E15. [PMID: 34973668 DOI: 10.3171/2021.10.focus21505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae. METHODS A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded. RESULTS A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non-TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited. CONCLUSIONS Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.
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Affiliation(s)
- Dhiraj J Pangal
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - David J Cote
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Jacob Ruzevick
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Benjamin Yarovinsky
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Guillaume Kugener
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Bozena Wrobel
- 2USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Elisabeth H Ference
- 2USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Mark Swanson
- 2USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Andrew J Hung
- 3USC Institute of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, California; and
| | - Daniel A Donoho
- 4Division of Neurosurgery, Center for Neuroscience, Children's National Medical Center, Washington, DC
| | - Steven Giannotta
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Gabriel Zada
- 1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles
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BAYRAM A, ESKİİZMİR G, CİNGİ C, HANNA E. Robotic Surgery in Otolaryngology-Head and Neck Surgery: Yesterday, Today and Tomorrow. ENT UPDATES 2020. [DOI: 10.32448/entupdates.780604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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Hachem RA, Rangarajan S, Beer-Furlan A, Prevedello D, Ozer E, Carrau RL. The Role of Robotic Surgery in Sinonasal and Ventral Skull Base Malignancy. Otolaryngol Clin North Am 2017; 50:385-395. [PMID: 28314404 DOI: 10.1016/j.otc.2016.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the past decade, robotic surgery has gained wide popularity, making a significant impact on multiple surgical specialties. In the head and neck arena, transoral robotic surgery has proven to be safe and associated with acceptable oncological and superior functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis; thus, changing the paradigm for the management of tumors in these anatomic locations. Robotic surgery of the ventral skull base is at an early stage of development. In this article reviews the literature discussing the role of robotic surgery in managing sinonasal and ventral skull base malignant lesions.
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Affiliation(s)
- Ralph Abi Hachem
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Sanjeet Rangarajan
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Andre Beer-Furlan
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Doan Hall 410 West 10th Avenue, Room N1011-A, Columbus, OH 43210, USA
| | - Daniel Prevedello
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Doan Hall 410 West 10th Avenue, Room N1011-A, Columbus, OH 43210, USA
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall - Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Doan Hall 410 West 10th Avenue, Room N1011-A, Columbus, OH 43210, USA.
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Rangarajan S, Hachem RA, Ozer E, Beer-Furlan A, Prevedello D, Carrau RL. Robotics in Sinus and Skull Base Surgery. Otolaryngol Clin North Am 2017; 50:633-641. [PMID: 28347482 DOI: 10.1016/j.otc.2017.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transoral robotic surgery (TORS) has been proven to be safe and to yield acceptable oncological and functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis. TORS has been successful at reducing morbidity, improving quality of life, and providing access to areas that previously required mandibulotomy or other more radical approaches in the past. This has changed the paradigm of management of tumors in these anatomic locations. In this article, the authors review the recent literature discussing the role of robotic surgery in managing sinonasal and skull base pathology and discuss its current advantages and limitations.
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Affiliation(s)
- Sanjeet Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ralph Abi Hachem
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall, Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Andre Beer-Furlan
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Daniel Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Doan Hall 410 West 10th Avenue, Room N1011-A, Columbus, OH 43210, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Starling Loving Hall, Room B221, 320 West 10th Avenue, Columbus, OH 43210, USA.
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9
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Richmon JD. Transoral palate-sparing nasopharyngectomy with the Flex®System: Preclinical study. Laryngoscope 2014; 125:318-22. [DOI: 10.1002/lary.24918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/03/2014] [Accepted: 08/15/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Jeremy D. Richmon
- Department of Otolaryngology-Head and Neck Surgery; Division of Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland U.S.A
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Rinaldi V, Pagani D, Torretta S, Pignataro L. Transoral robotic surgery in the management of head and neck tumours. Ecancermedicalscience 2013; 7:359. [PMID: 24073017 PMCID: PMC3782590 DOI: 10.3332/ecancer.2013.359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Indexed: 11/17/2022] Open
Abstract
The article reviews the use of robotic technology for head and neck tumours. The authors discuss the development of transoral robotic surgery (TORS), the current status of the technology, and the set-up in the operating room. The article provides a review of the literature, highlighting the applications, advantages, functional outcomes, and disadvantages of TORS for each anatomic subsite (oropharynx, hypopharynx, larynx, parapharyngeal space, and skull base). New challenges related to reconstruction are also presented. Overall early functional and oncologic outcome data are promising; further long-term prospective trials are still needed to confirm the oncological safety of TORS.
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Affiliation(s)
- Vittorio Rinaldi
- Department of Specialist Surgical Sciences, University of Milan, Otolaryngology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Blanco RGF, Boahene K. Robotic-Assisted Skull Base Surgery: Preclinical Study. J Laparoendosc Adv Surg Tech A 2013; 23:776-82. [DOI: 10.1089/lap.2012.0573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ray Gervacio F. Blanco
- Head and Neck Surgery, Department of Otolaryngology; and Head and Neck Surgery, Department of General Surgery, Johns Hopkins Head and Neck Surgery at Greater Baltimore Medical Center, Milton J. Dance Jr. Head and Neck Center, Baltimore, Maryland
| | - Kofi Boahene
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Sekhar LN, Tariq F, Kim LJ, Pridgeon J, Hannaford B. Commentary: Virtual reality and robotics in neurosurgery. Neurosurgery 2013; 72 Suppl 1:1-6. [PMID: 23254797 DOI: 10.1227/neu.0b013e31827db647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Taghi A, Ali A, Clarke P. Craniofacial resection and its role in the management of sinonasal malignancies. Expert Rev Anticancer Ther 2013; 12:1169-76. [PMID: 23098117 DOI: 10.1586/era.12.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Sinonasal malignancy is rare, and its presentation is commonly late. There is a wide variety of pathologies with varying natural histories and survival rates. Anatomy of the skull base is extremely complex and tumors are closely related to orbits, frontal lobes and cavernous sinus. Anatomical detail and the late presentation render surgical management a challenging task. A thorough understanding of anatomy and pathology combined with modern neuroimaging and reliable reconstruction within a multidisciplinary team is imperative to carry out skull base surgery effectively. While endoscopic approaches are gaining credibility, clearly, it will be some time before meaningful comparisons with craniofacial resection can be made. Until then, craniofacial resection will remain the gold standard for managing the sinonasal malignancies of the anterior skull base, as it has proved to be safe and effective.
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Affiliation(s)
- Ali Taghi
- Department of Otolaryngology, Head and Neck Surgery, St Bart's Hospital, Barts and the London Hospitals, London, UK.
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DALLAN I, CASTELNUOVO P, VICINI C, TSCHABITSCHER M. The natural evolution of endoscopic approaches in skull base surgery: robotic-assisted surgery? ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2011; 31:390-4. [PMID: 22323850 PMCID: PMC3272867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 09/12/2011] [Indexed: 11/25/2022]
Abstract
The current surgical trend is to expand the variety of minimally invasive approaches and, in particular, the possible applications of robotic systems in head and neck surgery. This is particularly intriguing in skull base regions. In this paper, we review the current literature and propose personal considerations on the role of robotic techniques in this field. A brief description of our personal preclinical experience on skull base robotic dissection represents the basis for further considerations. We are convinced that the advantages of robotic surgery applied to the posterior cranial fossa are similar to those already clinically experienced in other areas (oropharynx, tongue base), in terms of tremor-free, bimanual, precise dissection: the implementation of instruments for bony work and resolving current drawbacks will definitely increase the applicability of such a system in forthcoming years.
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Affiliation(s)
- I. DALLAN
- Address for correspondence: Iacopo Dallan, MD, Otorhinolaryngologic Unit, University of Insubria, via Guicciardini 9, 21100 Varese. Tel. +39 0332 278426. Fax: +39 0332 278945. E-mail:
| | | | - C. VICINI
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pietrantoni, University of Pavia in Forlì, Italy
| | - M. TSCHABITSCHER
- Department of systematic anatomy, University of Wien Manfred Tschabitscher and Claudio Vicini should equally be considered as last author
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