Robotic surgery keeps features intact in head, neck cancer removal procedures

May 13 2010

Surgeons who perform procedures to remove head and neck cancers often work for six to eight hours on what is typically major, invasive surgery, which many times comes with facial disfigurement and debilitating side effects for the patient.

Ho-Sheng Lin, M.D., F.A.C.S., leader of the Head and Neck Oncology Multidisciplinary Team at the Barbara Ann Karmanos Cancer Center in Detroit, is the first surgeon in Michigan to use the da Vinci® Surgical System to perform minimally-invasive surgeries on head and neck cancer patients who visit the center for treatment.

For patient Robert Spears, 70, of Detroit, there was no hesitation on his part when it came to choosing the minimally-invasive method.

"Using the robotic surgery was great because it kept my features intact," he said. "Robotic surgery was my No. 1 choice."

Spears is one of the patients whom Dr. Lin has operated on since he began performing surgeries using the da Vinci® Surgical System for head and neck cancers a year ago. Da Vinci has been used to treat prostate, urologic and gynecologic cancers in the past. It was approved by the FDA in January for surgery on the tonsils, base of tongue, supraglottis and pharyngeal wall.

"The da Vinci® Surgical System has made major changes in how we operate on head and neck cancer patients," Dr. Lin said. "In the past, we would be reluctant to operate on many of the patients with cancer involving the back part of the throat and voice box because of the high degree of morbidity associated with this type of surgery. We would typically recommend radiation or chemoradiation as the first line of treatment.

"Da Vinci is really making a big difference."

Spears noted that his health has mostly been great even though he had smoked since he was 14. He gave up smoking cigarettes when he was 49 and moved to a pipe.

It was only when he experienced a persistent sore throat starting in March of last year that he suspected something was wrong. As a retired sergeant first class of the Army, he visited the John D. Dingell VA Medical Center Emergency Room in Detroit and was diagnosed in October with cancer of the tonsils, the lymph nodes and the parathyroid. Doctors also discovered a large tumor on the base of his tongue.

People who are diagnosed with head and neck cancer, like Spears, typically have to prepare for major, invasive surgery that may require a surgeon to make long incisions through the jaw and throat to gain access to the oral cavity.

In Spears' case, Dr. Lin would have had to split his chin and break his jaw to perform the radical tonsillectomy, the tumor resection on his tongue, the removal of four teeth and surgery on the roof of his mouth – the sort of surgery that often results in facial disfigurement and difficulty eating, speaking and swallowing.

"With the old way of performing surgery, it's pretty hard to operate on the patient," Dr. Lin said.

With da Vinci, the same procedure takes only one or two hours. The da Vinci® Surgical System is a surgeon-guided robotic system that allows the doctor to perform the surgery through the mouth without the need for any external incision. The tiny robotic surgical instruments placed inside the mouth follow the exact movement of the surgeon's fingers and hand to execute precise and delicate procedures to remove cancerous tissue.

Da Vinci also comes with a three-dimensional, high-definition viewing screen, which provides the surgeon a clearer view of the operative field in the back part of the throat and voice box.

With the traditional surgical method, patients would be in the hospital recovering for one to two weeks. Dr. Lin mentioned that patients can leave the hospital in a few days after minimally-invasive robotic surgery. Other possible benefits of the da Vinci system include less blood loss, no visible scarring, no tracheotomy, fewer surgical complications and better cancer control.

Spears said that he is cancer-free today. Following the surgery, he went through chemoradiation, which he completed in mid-February of this year. Because of the surgery, his radiation oncologist Harold Kim, M.D., was able to reduce the radiation dose to the primary site which may potentially reduce the long term complications associated with high-dose radiation. He sees his Karmanos oncologist, Ammar Sukari, M.D., member of the Head and Neck Oncology Multidisciplinary Team, once a month for regular checkups.

Spears has regained his ability to swallow after losing that for two months. He is hoping to regain his sense of taste, which doctors have told him will return in three to six months. His voice has been affected, but he is able to eat most foods.

"I feel great," Spears said. "Dr. Lin was very nice and very thorough in explaining the procedure to me. I received wonderful service at Karmanos and everyone has been great."