Cho Hyung-Ju, Kang Ju Wan, Min Hyun Jin, Chung Hyo Jin, Park Do Yang, Ha Jong Gyun, Baek Seung Hak, Yoon Joo-Heon, Kim Chang-Hoon
Department of Otorhinolaryngology, Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.
Laryngoscope. 2015 Aug;125(8):1839-43. doi: 10.1002/lary.25283. Epub 2015 Apr 15.
OBJECTIVES/HYPOTHESIS: The objective of this study was to determine the potential role of a surgical robotic system in nasopharyngeal surgery using bilateral transantral or combined endonasal/transantral port.
The da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA) was used to perform dissection of the skull base on a whole fresh-frozen cadaver.
Bilateral mega-antrostomy was done with the usual endoscopic sinus surgery equipment. To obtain an accessible bilateral working space, posterior septectomy was performed. Next, bilateral anterior maxillary windows were created through a gingivobuccal incision. The 8.5-mm-diameter 0° or 30° three-dimensional camera arm was introduced into a nostril. The two 5-mm-diameter articulating EndoWrist arms entered through the transantral or endonasal port. For the dissection, Maryland articulated forceps, needle driver, and monopolar spatula- or hook-type electrocauterizer were used.
The 8.5-mm diameter of the camera arm was easily inserted into the nostril. Excellent access to the nasopharyngeal area from the level of the palate up to the skull base crossing the sphenoid prow was possible. Bilateral robotic arms were able to move inside the nasopharyngeal space, and the target dissection area could be accessed fully via the transantral or endonasal port.
This is the first report about the feasibility of bilateral transantral or combined transantral/endonasal port for robotic nasopharyngectomy. Robotic removal of the entire nasopharyngeal area was successfully achieved without transpalatal or facial skin incision. These new approaches may be applied to selected patients with nasopharyngeal carcinoma or other pathologic tumors involving the nasopharynx.
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目的/假设：本研究的目的是确定手术机器人系统在使用双侧经鼻窦或联合鼻内/经鼻窦入路的鼻咽癌手术中的潜在作用。
使用达芬奇机器人（直观外科公司，加利福尼亚州桑尼维尔）在一具完整的新鲜冷冻尸体上进行颅底解剖。
使用常规的鼻内镜鼻窦手术设备进行双侧大鼻窦切开术。为获得可进入的双侧工作空间，进行后鼻中隔切除术。接下来，通过牙龈颊侧切口创建双侧上颌前窗。将直径8.5毫米的0°或30°三维摄像臂插入一侧鼻孔。两根直径5毫米的可弯曲EndoWrist臂通过经鼻窦或鼻内入路进入。解剖时，使用马里兰可弯曲钳、持针器和单极铲形或钩形电灼器。
直径8.5毫米的摄像臂很容易插入鼻孔。从腭部水平到穿过蝶骨嵴的颅底，能够很好地进入鼻咽区域。双侧机器人臂能够在鼻咽腔内移动，通过经鼻窦或鼻内入路可完全到达目标解剖区域。
这是关于双侧经鼻窦或联合经鼻窦/鼻内入路用于机器人辅助鼻咽癌切除术可行性的首次报告。成功实现了在不进行经腭或面部皮肤切口的情况下机器人切除整个鼻咽区域。这些新方法可能适用于选定的鼻咽癌患者或其他累及鼻咽部的病理性肿瘤患者。
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