Robot-Assisted Transoral Trans-Hard Palate Corridor to the Ventral Skull Base: A Cadaveric Feasibility Study.

Abstract

Robot-assisted surgery offers high-precision, minimally invasive access to confined spaces. Although transoral approaches using soft-palate splitting can reach the sella and clivus, they may be associated with velopharyngeal dysfunction. To date, no robotic technique reportedly preserves the soft palate while providing continuous access from the anterior skull base to the craniovertebral junction. To evaluate, in a cadaveric model, a robotic transoral trans-hard-palate approach that creates a single midline corridor from the planum sphenoidale through the sella and clivus to C2, and to test whether this corridor permits representative deep skull base maneuvers using dural suturing and simulated vascular repair. Six fresh cadaver heads were studied using the da Vinci Xi system. An arcuate hard-palate osteotomy allowed temporary mobilization on a vascular pedicle. Submucosal septal dissection with removal of the vomer and anterior/inferior sphenoid walls exposed a midline corridor from the planum to C2 while preserving the soft palate. Dural defects at the sellar-planum region and clivus were reconstructed with fascia lata and 7-0 Prolene. Additional experiments included formal reconstruction of suturing at the craniovertebral junction and simulated internal carotid artery (ICA) injury repaired with temporary clipping and 8-0 Prolene. The approach provided a stable 20-mm working channel for deep maneuvers. Robotic instrumentation allowed dural suturing at the sellar-planum region and clivus, additional suturing at the craniovertebral junction, and technically feasible ICA repair. This cadaveric study demonstrates a soft-palatal-preserving robotic transoral trans-hard-palate corridor capable of accommodating key skull base maneuvers. The technique may, in the future, complement expanded endoscopic endonasal approaches for selected midline lesions; however, endoscopic endonasal approaches remain the clinical standard, and in vivo validation is essential.