Robotic surgery of the anterior skull base

Background: Significant advances have been made in transoral robotic surgery (TORS), yet its application in anterior skull-base surgery has yet to be defined. This work explores the history of endoscopic sinus and anterior skull-base surgery, and its advantages and disadvantages. The development of robotic surgery is then discussed as well as the advantages and disadvantages of TORS as it relates to the anterior skull base. The current applications for robotic surgery to the anterior skull base are presented with details of future applications. Methods: A structured search of the current literature using MEDLINE, PubMed, and EMBASE was performed from inception to May 2019. Search terms related to topics of robotic skull-base surgery were identified and queried to identify relevant articles. Results: Fifty-four papers were identified from the literature search and a hand search of the references. Twenty-one other references were discovered from personal communication, websites, and books relevant to the topic. Conclusion: Anterior skull-base surgery has the potential for significant morbidity compared to head and neck surgery, yet the application of the robot in sinus and anterior skull-base surgery has yet to be formally defined. Currently, there are certain limitations that need to be overcome; however, research to address these barriers is currently underway and promises an exciting future for robotic sinus and anterior skull-base surgery.