Tumors on the tongue and in the throat are hard to reach, typically requiring extensive and disfiguring surgery with prolonged rehabilitation. But da Vinci Transoral Robotic Surgery (TORS) improves efficiency while reducing recovery times for early to mid-stage cancers from months to days, as evidenced by recent work at Nepean Hospital in New South Wales, Australia.
“Without the robot, tongue and throat cancers are among the most difficult tumors to surgically remove. Surgeons make a very large incision across the throat, almost from ear to ear, and split the lower jaw at the chin to get to the tumor at the base of the tongue,” said associate professor and head and neck surgeon Ronald Chin, Bsc(Med), MBBS.
“Skin grafts and plates are needed to help close the large wound and reconstruct the patient’s face,” said Chin. “After the surgery, patients require months of therapy to learn how to swallow and talk again. The operation itself and the postoperative rehabilitation are traumatic and difficult for patients and their families.”
With TORS, surgeons simply open the patient’s mouth and direct the robot’s arms to go inside and remove the cancer. The surgeon is in complete control of the robot, 100% of the time. TORS provides a high-definition, 3-D view of the tumor as surgeons manipulate its tiny wristed instruments, which bend and rotate farther than the human hand can.
Clinically suitable patients are given general anesthetic for the procedure, which takes about 45 minutes. Removing such tumors without the robot usually takes about 12 hours, followed by 5 to 7 days of intensive care and 2 to 3 more weeks in the hospital. But patients who are treated with TORS can eat and drink just 24 hours after the cancer is removed and are home in 2 days.
For example, patient Brian Hodge had a large tumor at the base of his tongue. He already had been treated with radiation therapy for other head and neck cancers that made his skin and muscle particularly difficult for a surgeon to work with. His prognosis for recovery from invasive facial surgery was not good.
“When Dr. Chin said we’ll use the robot instead of having your face cut open, I said ‘Let’s do it,’” said Hodge. “I was home in 2 days. No scars. It was just such a great feeling to wake up and not have your face cut open because they used the robot.”
Hodge can eat, drink, swallow, and talk, and he’s even ready to sing karaoke again just weeks after the procedure as his life returns to normal.
“We are here to provide the best possible service to our patients, and that includes doing our best to maintain their quality of life,” said Chin. “I’m very honored to be able to offer the robotic procedure to our patients and proud that Nepean Hospital is delivering a world-class service.”