Robotic surgery of the infratemporal fossa

Objective: To develop a minimally invasive technique for robotic access to the infratemporal fossa and describe the technical feasibility of using surgical robotics in this application. Design: A feasibility study of robotic dissection of the infratemporal fossa using a novel, midline suprahyoid port placement. Cadaveric dissections were performed through the lateral pharyngeal wall into the infratemporal fossa with identification and preservation of the lingual n., inferior alveolar n., internal and external carotid arteries, jugular vein, and CN IX-XII. Surgical clips were placed at the extent of dissection, and CT imaging confirmed access to the respective skull base foramina. Setting: Tertiary Care Cancer Hospital Patients: A total of six complete and two partial dissections of the infratemporal fossa were carried out on 1 fixed and 3 fresh cadaveric heads using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA). Results: CT imaging shows surgical clips placed successfully at the skull base foramina of major neurovascular structures of the infratemporal fossa. Conclusions: Robotic surgery offers several advantages over traditional endoscopic surgery with the addition of tremor-free, two-handed technique and microscopic 3-D visualization. A midline suprahyoid port placement provides minimally invasive access for excellent exposure of the infratemporal fossa bilaterally.