Da Vinci Transoral Robotic-assisted Surgery of Pituitary Gland

Over the past 30 years, endoscopic transnasal techniques have gained a major interest, and anatomic limits have been widened in order to extend neurosurgical applications. For many years, robotic-assisted surgery using the da Vinci system (Intuitive Surgical Inc, Sunnyvale, California, USA) has been greatly developed, especially in urology and gynecology. Robotic-assisted surgery has been performed for pharyngeal and laryngeal cancers in a minimally invasive perspective. A robot-assisted preliminary series demonstrated the ability to approach the sella via oral approach without traumatic injury of nasal or oral cavity. Transoral approach avoids the complications of the endonasal resection: synechia, rhinitis sicca anterior, primary and secondary atrophican rhinitis, and empty nose syndrome. The investigators recently published a cadaveric study of transoral robotic-assisted skull base surgery to approach the sella turcica (Neurosurgical Rev. 2014; 37:609-17). In this study, the investigators will propose a new minimally invasive technique of pituitary surgery by transoral approach assisted by the da Vinci robot in patients with pituitary adenoma.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* Pituitary adenoma with a surgical indication : visual compression and chiasmal syndrome, intracranial hypertension , hormonal syndrome (hypopituitarism and hypersecretion ) , failure of medicamentous treatments for prolactinoma
* No pituitary apoplexy (requiring emergency surgery)
* Spontaneous oral opening greater than 35 mm

Exclusion Criteria:

* Insufficient buccal opening
* Intercurrent pathology of oropharyngeal and nasopharyngeal
* Complicated forms of adenoma pituitary adenoma (invasive adenoma)
* Hemostasis disorder
* Phlebitis or active pulmonary embolism