Researchers at the UCLA Jonsson Comprehensive Cancer Center have developed a technique to perform cancer surgery on a previously-unreachable area of the head and neck with robotic-assisted surgery. The findings were published online on December 9 in the journal Head & Neck.
The study authors note that the new procedure can be used safely and efficiently in patients to remove tumors that often were previously thought to be inoperable, or required the use of highly-invasive surgical techniques in combination with chemotherapy or radiation therapy. The procedure was developed by lead author Dr. Abie Mendelsohn, UCLA Jonsson Comprehensive Cancer Center member and director of head and neck robotic surgery at UCLA. The robotic approach provides the surgical community with a cutting-edge technology roadmap to treat patients who had little or no hope of living cancer-free lives.
“This is a revolutionary new approach that uses highly advanced technology to reach the deepest areas of the head and neck,” explained Dr. Mendelsohn. He added, “Patients can now be treated in a manner equivalent to that of a straightforward dental procedure and go back to leading normal, healthy lives in a matter of days with few or even no side effects.”
The parapharyngeal space is pyramid-shaped area that is near the base of the skull and connects several deep compartments of the head and neck. It is lined with numerous large blood vessels, nerves and complex facial muscle; thus, making access to the space via traditional surgical procedures often impossible or highly invasive. Current surgical techniques can require that external incisions be made to the patient’s neck, or the splitting of their jaw bone or areas close to the larynx (voice box). In addition, radiation therapy and chemotherapy are often required; thus, further complicating recovery and potentially putting patients at risk for serious (or even lethal) side-effects.
Trans Oral Robotic Surgery (TORS) was approved by the Food and Drug Administration in 2009. It uses the Da Vinci robotic surgical system. The technologically advanced procedure was developed at UCLA by the specialized surgical program for the head and neck. TORS is a minimally invasive procedure in which the robot, under the full control of a specially trained physician, operates with a 3-D, high-definition video camera and robotic arms. These arms can navigate through the small, tight and delicate areas of the mouth without the need for external incisions. A retraction system allows the surgeon to view the entire surgical area at once. The surgeon sits at an operating console a few steps away from the operating table. Every movement of the surgeon’s wrists and fingers are transformed into movement of the surgical instruments.
During the development phase of the procedure, Dr. Mendelsohn refined, adapted, and advanced the TORS techniques to allow surgical instruments and the 3-D imaging tools to access and operate safely within the parapharyngeal space. At present, Dr. Mendelsohn’s new procedure primarily benefits patients with tumors located in the throat near the tonsils and tongue; however, it continues to be adapted and expanded in scope and impact.
“We are tremendously excited about the possibilities for the surgical community with this new advancement of TORS,” noted Dr. Mendelsohn. HE ADDED, “Now patients have options they never had before, and we can even develop potential applications for the procedure beyond the surface of the head and neck.”
One Patient’s Story:
In 2012, David Alpern received shattering news. He was diagnosed with throat cancer, and the treatment options given to him by his doctors appeared to be worse than the disease. “They described a procedure where your face is split in half and it’s basically reconstructive surgery. I was completely freaked out,” explained, Mr. Alpern. After a thorpugh examination and imaging by Dr. Mendelsohn at UCLA, the surgeon determined that David was a perfect candidate for TORS. The husband and father of two was soon up and about in a matter of days following the procedure. Similar to more than 100 TORS surgeries performed by Dr. Mendelsohn, David’s tumor was removed and he is now completely cancer free. “I try not to get too cocky or excited that I beat cancer, but I think I did,” said Mr. Alpern. He added, “There are no side effects at this point. My hopes are just to watch my kids grow up and enjoy my family and my life.”