Transoral Robotic Surgery Applied to the Skull Base

Abstract

Skull base surgery has been developed with transsphenoidal approaches to reach the sella and especially the pituitary tumors. Transnasal endoscopic technique has become the gold standard for many years. Indeed, the intraoperative view with specific endoscope is very good, and thus the gross total of pituitary adenomas removal rates have been increased. Nevertheless, why has not this technique been challenged, especially given the potential rhinologic side effects and 2D vision? Robotic surgery with the da Vinci system is now well known all over the world. Transoral robotic surgery (TORS) is also commonly used in head and neck cancer with satisfying results. In this ENT approach, the da Vinci videoendoscope looks downward; we had the idea to place it behind the hard palate in order to look upward. Therefore, from cadaveric studies to clinical “première mondiale,” we developed an innovative TORS to reach the sella and to remove pituitary tumors.