Robotic-Assisted Surgery in Skull-Base Procedures: Advances, Applications, and Emerging Innovations

Robotic-assisted surgery (RAS) is increasingly used in skull-base procedures due to its enhanced visualization, precision, and ergonomics, particularly in anatomically-constrained regions. The present narrative review explores the current role and emerging frontiers of RAS in anterior and lateral skull-base surgeries within otolaryngology and neurosurgery.

We conducted a comprehensive narrative review of studies published throughout the past 2 decades on the PubMed, Scopus, and Web of Science databases using keywords such as robotic skull-base surgery , transoral robotic surgery , and robotics in otolaryngology . We included studies detailing robotic interventions in anterior and lateral skull-base pathology.

Robotic platforms-such as the da Vinci and KUKA systems-have demonstrated efficacy in pituitary-adenoma resection, sinonasal-tumor management, cochlear implantation, and mastoid drilling. The benefits reported include improved access, reduced instrument collision, tremor filtration, and enhanced surgical ergonomics. Institutional data and case studies indicate outcomes comparable or superior to those of the traditional approaches in select cases. Nonetheless, challenges remain, including high costs, limited training availability, and technical complexity.

Robotic-assisted surgery has demonstrated clinical value in skull-base surgery, and it has the potential of improving outcomes while minimizing surgeon fatigue. Broader adoption will depend on cost reduction, widespread training, and technological advancements. Emerging innovations-including the integration of artificial intelligence, image-guided navigation, and instrument miniaturization-may further expand its usefulness in complex skull-base interventions.