Transantral Robotic Access to the Pituitary Gland

The prevalence of pituitary tumors exceeds 15 percent in the general population, and over 5000 pituitary surgeries are performed yearly in the United States. Various surgical approaches to the sella have been described, but the most commonly used approach is the sublabial technique with a microscope-assisted surgical resection. Over the last decade, however, there has been an evolution toward a transnasal endoscopic approach, an approach that has found favor at a number of institutions. The application of robotic technology to surgery has rapidly expanded over the last five years. A certain advantage that these novel systems offer is the ability to perform bimanual surgery in confined cavities with instrumentation that exceeds the capabilities of the human hand, providing the surgeon with a three-dimensional view of the surgical field. Significant advances in surgical robotics have been made, although a role for roboticbased applications in skull-base surgery has not been completely defined. To explore the potential of robotic technology in pituitary surgery, we developed a novel approach that allows endoscopic access for resection of tumors involving the pituitary fossa.