Multiportal Approach to Skull Base Combining Endoscopic Transnasal Surgery and Transoral Robotic Surgery with Da Vinci Xi System: Feasibility Assessment and Clinical Cases

Abstract

Introduction: In the past two decades, transnasal endoscopic surgery has made major progress, extending its indications from functional sinus surgery to skull base, sinonasal and nasopharyngeal tumors. In several recent publications, nasopharyngeal endoscopic resection (NER) showed promising oncologic results compared with reirradiation for recurrence of nasopharyngeal carcinoma. However, some tumor extensions such as below the hard palate or the impossibility to suture local flaps (e.g., nasoseptal flaps) are some limitations of trans-nasal endoscopic surgery. Recently, trans-oral robotic surgery (TORS) has emerged as an innovative tool that provides 3-dimensional visualization and 2-robotic-arm surgery allowing bimanual dissection and sutures.