Twenty-five years ago, a patient with mouth or throat cancer faced disfiguring, open surgery that required breaking the jaw and splitting the lip and mandible to reach tumors lodged deep in the throat or at the back of the tongue. Early attempts at removing these tumors through the mouth, known as transoral surgery, were limited by rudimentary optics and constrained by the inability to use multiple tools at once.
Enter the DaVinci robot five years ago. With greatly improved optics, precision instrumentation and the ability to fit multiple instruments in the mouth at once, surgeons can now perform advanced surgeries via the mouth for tumors deep in the throat, esophagus or at the back of the tongue. The robot is also used for reconstructive work, such as repairing scarring and injury in patients with complicated swallowing or breathing problems. Known as transoral robotic surgery, or TorS, Stanford is one of the few places in the country using the DaVinci surgical robot for head and neck surgeries.
"The robot has really energized the field of transoral surgery," says Stanford head and neck surgeon Edward Damrose, MD, chief, division of laryngology, and associate professor, department of otolaryngology/head & neck surgery. "It is helping us accomplish procedures endoscopically that a few years ago would likely have not been possible."
Improved treatment options
As Damrose describes, he can deploy the robot through the mouth, which gives him binocular vision, depth perception, dexterity and reach far beyond what was available 50 years ago. These advances allow him to perform surgeries through the mouth with no incisions, which means a significant reduction in morbidity to the patient.
"We can avoid tracheotomy, which used to be mandatory, lessen blood loss and offer patients a faster return to swallowing function," he explains. "The robot also gives us the ability to preserve the function of healthy tissue while removing the diseased tissue. The more healthy tissue we can preserve, the better patients will swallow, the better they'll speak and the better the outcome."
The vast majority — 90 percent — of malignant tumors that appear in the mouth, the base of the tongue and the throat are squamous cell carcinomas. And the incidence of these cancers is increasing at a fairly alarming rate, according to Damrose, affecting younger people in their 40s, 50s and 60s. Many experts are associating this trend with the spread of human papillomavirus (HpV). "Transoral robotic surgery will allow these younger patients a less invasive and less morbid approach to curing their cancer," says Damrose, "thus preserving more treatment options for them in the future in case they develop secondary tumors."