Robotic surgery dramatically reduces physical trauma for head and neck cancer patients

Philadelphia 17 May 2005For patients with cancer of the mouth and throat, surgery is a frequent course of treatment, often leading to speech and swallowing dysfunction and external scarring. Researchers from the University of Pennsylvania (PENN) School of Medicine's Department of Otorhino-laryngology/Head and Neck Surgery, have completed two studies - the most comprehensive and largest to date - that demonstrate the effective use of the daVinci Surgical Robotic System to perform Trans-Oral Robotic Surgery (TORS) which greatly reduces surgical trauma for patients. Their initial findings were presented at the recent combined Annual Meetings of Otorhino-laryngology (ear, nose and throat) Experts - the Triologic Society in Boca Raton, Florida.

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PENN physicians anticipate that the application of the daVinci System to treat mouth and throat cancers will allow for complete tumour removal while helping to preserve voice and swallowing function. "The daVinci Robot has been FDA-approved and successfully integrated into cardiac and urologic surgery. Patients are reaping the benefits with decreased bleeding, less pain, and are able to return to work sooner", stated otorhino-laryngologist Neil G. Hockstein, MD, who served as lead investigator for both studies. "I saw the potential to apply the attributes of surgical robotics to the treatment of head and neck cancer and we've successfully devised novel approaches to introduce the robotic arms through the mouth into the throat and voice box."

For head and neck tumours, treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure. Conventional cancer surgery can consist of an almost ear-to-ear incision across the throat or splitting the jaw in half. This can result in speech and swallowing deficits for patients. "The research we've done to date suggests that TORS has great potential to improve the way we treat head and neck cancer patients", stated Bert O'Malley, Jr., MD, Chair of PENN's Department of Otorhino-laryngology/Head and Neck Surgery. "We believe this technology will have a dramatic impact on the ability to completely remove tumours while preserving speech, swallowing, and other key quality of life issues."

In the first study, researchers used the daVinci Robot and "operated" on a mannequin. They found that, by applying simple instruments and retractors commonly used for tonsillectomy, the robotically controlled camera and instruments could be inserted through the mouth into the throat and voice box. The surgeons were able to manipulate different elements in the voice box with a high degree of dexterity that would be tremendously difficult using conventional instruments. They were also able to suture and tie knots deep in the mannequin's throat with relative ease - a task exceptionally challenging without the aid of robotic technology.

In the second study, the surgeons performed a variety of surgical procedures on a human cadaver. They concluded that robotic surgery may shorten operating time and allow for minimally invasive treatment of more cancer patients.

The self-contained daVinci robotic system has three main components: a mechanical robot with three multi-jointed arms; a computer command centre several feet from the patient, where the doctor sits, and a 3D computer monitor similar to a "viewfinder" that affords a magnified view of the surgical site inside the patient. Equipped with a special, double-telescopic endoscope, the viewfinder allows surgeons to see the surgical site more closely than human vision allows, and to work at a smaller scale of detail than conventional surgery permits.

Unlike other endoscopic systems now in use, which afford reverse-image views that require counter-intuitive movements by surgeons - whereby the surgeon must move his hand to the left in order to move the mechanical device to the right, the daVinci technology affords surgeons the direct, "intuitive" control they exercise in traditional open surgical procedures, seamlessly translating their natural hand, wrist and finger movements at the console into corresponding micro-movements of laparoscopic surgical instruments inside the patient's body.

Additionally, the robot is computer controlled to eliminate any tremors and allow for steady, precise movements. "When operating with the daVinci System, the optics and fluidity of instrument movement are just amazing", added Dr. Hockstein. "It has the potential to add great precision to our surgical treatment of a variety of diseases of the head and neck."

PENN Medicine is a $2,5 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine, founded in 1765 as the United States' first medical school, and the University of Pennsylvania Health System, created in 1993 as the nation's first integrated academic health system.

Penn's School of Medicine is ranked number 3 in the nation for receipt of NIH research funds; and ranked number 4 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1400 full time faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

Penn Health System is comprised of its flagship hospital, the Hospital of the University of Pennsylvania, consistently rated one of the nation's "Honour Roll" hospitals by U.S. News & World Report; Pennsylvania Hospital, the nation's first hospital; Presbyterian Medical Center; a faculty practice plan; a primary-care provider network; two multi-speciality satellite facilities; and home health care and hospice.

More daVinci Robot System news can be found in the VMW April 2005 article Iowa baby to receive life-saving robotic surgery by University of Iowa doctors using da Vinci.


Leslie Versweyveld

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