Combined transoral transnasal robotic-assisted nasopharyngectomy: a cadaveric feasibility study
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- Dallan, I., Castelnuovo, P., Montevecchi, F. et al. Eur Arch Otorhinolaryngol (2012) 269: 235. doi:10.1007/s00405-011-1550-x
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Surgical management of the nasopharynx is complex. Both traditional and endoscopic transnasal techniques are demanding. Purely transoral robotic nasopharyngectomy has been described but it needs a palatal splitting and is performed with an inferior to superior perspective with a difficult vision of the upper regions. The aim of this study is to investigate a new robotic surgical setting, which is able to overcome the actual limits. The DaVinci Surgical System was used in two cadavers. Dissection was carried out through a combined transnasal–transoral approach and a purely transoral procedure. A complete nasopharyngectomy was performed with both settings. Working and setting times are comparable. The combined approach avoids palatal spitting and permits a more panoramic view of the surgical field with an easier dissection of the upper areas. A robotic palatal sparing nasopharyngectomy is feasible. The combined transnasal–transoral setting seems to offer significant advantages with respect to traditionally purely transoral procedures.