Patient Care

University of Rochester Expands Robotic Surgeries to Oral, Pharyngeal Cancers

Feb. 16, 2010

Doctors at University of Rochester Medical Center are first in upstate New York to incorporate the precision and dexterity of a surgical robot to remove cancerous tumors in the mouth and throat.

The first transoral robotic procedure – a partial glossectomy -- was performed Feb. 8 by surgeon Matthew Miller, M.D. This procedure expands the Medical Center’s robot-assisted surgery capabilities to include procedures for head and neck, urologic and gynecologic conditions.

“Traditional approaches to these tumors have the potential to be invasive and disfiguring – oftentimes leading to an extensive recovery and rehabilitation period,” said Miller, a fellowship trained head and neck cancer surgeon. “The robot allows us to limit or even eliminate some of the side effects associated with more invasive surgeries while still effectively treating the cancer.”

Sveta Karelsky, M.D., guides instruments during a robot-assisted surgery for head and neck cancer, the first in upstate New York.

“It offers greater visuals and flexibility in getting at tumors that are very hard to reach. The 3-D visuals are so much better and the instruments give us 360-degree maneuverability, which means we’re able to perform surgeries with greater precision than ever before.”

Strong Memorial Hospital’s daVinci Surgical Systems consist of robotic arms that replicate a surgeon’s motions in real time. The movements are by a surgeon using high-definition images provided by cameras positioned within the patient’s mouth. The surgeon is working from a console, across the room from the patient.

Traditional surgery for some head and neck cancers requires large incisions – extending from the lip, across the chin and to the neck before entering the mouth or throat. Many times surgeons need to cut through the lower jaw and move aside vital cranial nerves to gain access to the back of the mouth and throat.

Using the high-precision robotic system, surgeons insert the slender instruments into the mouth to reach the base of the tongue, tonsils, oropharynx and throat.

The benefits for people with head and neck cancers are dramatic because the surgeries can be done, primarily, without incisions and offer faster recovery time and a reduced risk of infection or other complications. The jaw is left intact and the cranial nerves are avoided.

“Unfortunately, therapies for head and neck cancers haven’t offered any significant increase in survival over the past several decades. Yet our ability to improve our treatments – through surgical advances such as robotics, targeted radiation therapy and better chemotherapies – has had a dramatic impact on the quality of our patients’ lives,” said Miller, assistant professor of Otolaryngology and the James P. Wilmot Cancer Center. Oral cancers affect about 28,500 people in the United States each year.

‘Complete Confidence’

George Maines of North Greece didn’t expect a cancer diagnosis when he pointed out a lump on his neck to his doctor. He’d noticed it when he was shaving, but ignored it, figuring that it would go away on its own.

When it didn’t go away, he mentioned it to his doctor. Testing showed a 2-inch tumor in a lymph node and doctors suspected it had spread from someplace else. Further investigation showed a tumor on the base of his tongue, the primary source of the cancer.

The Wilmot Cancer Center’s multidisciplinary head and neck cancer team – which includes otolaryngologists, oncologists, radiation oncologists and speech pathologist, nurses and other support staff -- reviewed Maines’ scans and test results and determined that surgery followed by radiation therapy would be the best way to treat the disease.

Faced with the two surgical options, Maines chose the less invasive procedure. “I put all of my faith in Dr. Miller and I had complete confidence that the robot would be the best way and everything will turn out well,” said Maines, 72, a retiree from Eastman Kodak Co.

Miller removed the tumor from his tongue using the robotic system and then made a small incision on his neck to remove the cancerous lymph nodes.

Robotic revolution

The volume of robotic surgeries has risen dramatically in the past decade, as demand for the minimally invasive approach grows and surgeons grow more comfortable with the technology.

Strong Memorial Hospital has two surgical robots, and a third is located at Highland Hospital. Strong was first in the region to introduce the daVinci Surgical System in 2003, and since then, surgeons have performed more than 2,500 procedures for urologic and gynecologic conditions.

The Medical Center is creating a Center for Robotic Surgery and Innovation to expand the use of robotic technology at Strong Memorial Hospital and expand research into its use. The center will also provide hands-on education for doctors who want to specialize in robot-assisted surgeries and use techniques honed by our surgeons.

“As the medical community embraces robotic-assisted surgery, our researchers, nurses, and surgeons will continue to lead this field,” said Jean V. Joseph, M.D., head of the section of laparoscopic and robotic urologic surgery.

“This will offer our patients significant benefits because the quality and experience of our surgeons will surpass all others. We are at the forefront of this field,"Joseph said.

During a robot-assisted surgery using the daVinci Surgical System, patients are positioned as they would be during laparoscopic surgery, with medical personnel surrounding them, yet a surgeon is located at a console a few feet away.

Supporting surgical team members install the correct instruments, and supervise the laparoscopic arms and tools being used. The instruments are designed with seven degrees of motion that mimic the dexterity of the human wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation.

Although the surgeon is not physically in contact with the patient, the daVinci control console allows the surgeon to actually see the surgical field in enhanced detail as a result of the three-dimensional image transmitted from the laparoscopic cameras. The surgeon manipulates the robotic “hands” in real-time using master controls, seeing minute, 3-D details inside the patient with the aid of the cameras located inside the patient. The two robotic arms and one laparoscopic arm execute the surgeon’s commands.