Robot arm helps surgeons treat mouth cancer in just one hour – and with no scars
21:46 GMT, 9 June 2012
No pain: Stephan Spiriak was home within a week of having the operation
Pioneering robotic surgery is allowing doctors to remove cancer in the mouth without leaving a scar.
Until now the only way to remove cancer of the oropharynx – the hard-to-reach area at the back of the mouth which encompasses the tonsils and base of the tongue – has been to split the jaw, take out the cancer and repair the neck with tissue from the forearm.
This ten-hour procedure requires two surgical teams and often has complications. Patients are in hospital for at least three weeks and need months of rehabilitation to help them swallow and speak again.
Because the treatment is so invasive, many doctors try to avoid it by using chemotherapy and radiotherapy instead.
However, this can cause long-term swallowing problems and up to 40 per cent of patients need to be tube-fed afterwards. Furthermore, surgery is often the best chance of a cure.
The new one-hour technique, called TransOral Robotic Surgery, allows the cancer to be removed without splitting the jaw or taking tissue from other parts of the body. Instead, the tonsils are accessed through the mouth using a specially designed Da Vinci robotic machine.
Developed in the US, where it is more widely used, the procedure allows surgeons to carry out the operation from a computer-controlled console which gives them 3D images of inside the mouth.
Their hands are placed in robotic arms which give them greater precision, dexterity and accuracy to remove the cancerous tumour while the mouth is clamped open.
And because the tumour is grasped by robotic cutters and left as an open wound to heal naturally – a process known as healing by secondary intention – the patient requires no stitches and there is no scar.
Although the operation costs 5,000, it saves the NHS money compared with conventional surgery because it involves just one surgeon and a hospital stay of only six days.
Infection rates are also reduced, which speeds up recovery, and patients are able to swallow normally soon afterwards and require no long-term feeding tubes.
TransOral Robotic Surgery: The new one-hour technique allows the cancer to be removed without splitting the jaw or taking tissue from other parts of the body
Fifty UK patients have had the surgery, which is available on the NHS and privately.
However, Neil Tolley, a consultant head and neck surgeon at Imperial College Hospital and the Wellington Hospital, London, who has pioneered technique in the UK, says the procedure could transform the treatment of mouth cancers for thousands.
Cases of squamous cell carcinoma – the most common type of mouth cancer – have increased threefold in recent years, with 6,000 new cases reported in the UK in 2009.
The disease can be caused by smoking and alcohol consumption but it is also linked to the human papillomavirus.
‘The mouth is a small place and the robot allows access to anatomical sites and permits surgery which would otherwise be technically very difficult or impossible to perform conventionally,’ says Mr Tolley.
‘The instruments can move through 270 degrees and the robotic arms mean limitations of human anatomy can be overcome, so the left hand is as adept as the right and there is no tremor.’
Rise: Cases of squamous cell carcinoma – the most common type of mouth cancer – have increased threefold in recent years
Three weeks after the operation, patients have a second procedure on their lymph glands in the neck which involves a further 24-hour hospital stay.
After the operations, tissue taken from the tonsils and tongue is analysed to see whether radiotherapy or chemotherapy is needed.
One of the first patients to benefit is Stephan Spiriak, 55, a semi-retired electrician from Edgware, North London.
After he had suffered a sore throat for weeks, tests in February revealed that he had cancer of the tonsils.
Immediately he was told he was suitable for the new, less invasive surgery.
‘I was in intensive care for three days but there was no pain, just discomfort of the tubes in my nose and mouth,’ he says. ‘After five days I was on liquids again and I was allowed home within a week. Within ten days I was eating normally.
‘The traditional operation requires huge incisions and it can take months to recover your eating and speech, so I was delighted to have this surgery.’