Transoral robotic surgery of craniocervical junction and atlantoaxial spine: a cadaveric study

Laboratory investigation

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  • 1 Departments of Neurosurgery and
  • 2 Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
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Object

The goal of this study was to determine the potential role and current limitations of the da Vinci surgical robot in transoral decompression of craniocervical junction (CCJ).

Methods

The da Vinci Surgical System was used in 2 cadaver heads with neck and clavicles intact. Both neurosurgeons and otolaryngologists familiar with the open microscopic procedure, as well as the transoral robotic surgical procedure, undertook dissection and decompression of the CCJ.

Results

The robotic system provided superb illumination and 3D depth perception even several centimeters deep to the posterior oropharyngeal mucosa. The 30° endoscope improved cephalad visualization, eliminating the need to split the soft palate for exposure of the lower clivus. The “intuitive” nature of the da Vinci surgical robot arms provided an advantage in allowing the ability to suture the dura mater in a deep, dark corridor. Because visualization was excellent, tremor-free closure was possible.

Conclusions

The authors' findings suggest that transoral robotic surgery, with the da Vinci robot system, holds great potential for decompression of the CCJ as well as resection of both extra- and intradural tumors of this region. Further instrument development is necessary and continued investigation is warranted.

Abbreviations used in this paper:CCJ = craniocervical junction; TORS = transoral robotic surgery; VB = vertebral body.

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Contributor Notes

Address correspondence to: John Y. K. Lee, M.D., Department of Neurosurgery, 3 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. email: leejohn@uphs.upenn.edu.

Drs. Lee, O'Malley, Newman, and Weinstein contributed equally to the study and are thus considered first authors.

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