Head and Neck Cancer Robotic Surgery

Transoral Robotic Surgery (TORS)

Surgery is one option for treating oropharynx tumors – cancers occurring in the throat, base of the tongue, and tonsils. Conventionally, removing tumors through surgery required a very large neck incision and cutting of the bottom jaw. This left patients with difficulty in swallowing and speaking. Today, advances in surgical equipment have made it possible to reach orophayrngeal tumors through incisions in the mouth by using robotic technology.  More information?  Contact head and neck cancer surgeon Jeremy Richmon, M.D., at 410-955-6420.

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Who Benefits?

Patients that may benefit most from robotic procedures include those with early stage tumors with little or no lymph node involvement in the neck. Approximately 10 to 20 percent of patients with oropharygeal tumors may be considered ideal candidates for the procedure. Patients who smoke tobacco or have HPV negative tumors are especially encouraged to receive a primary surgical treatment for their cancer as these cancers often do not respond as well to radiation and chemotherapy.

What are the Benefits?

Studies have shown that the outcomes of such procedures – called transoral robotic surgery – result in swallowing and speech function that is as good or better than other surgical methods, but without disfiguring scars. While up to 20 percent of patients who receive combination chemotherapy and radiation may have feeding tubes inserted for an average of five years, zero to 5 percent of patients undergoing transoral procedure need the tubes during the same time.

For physicians performing TORS, a guided endoscope helps create a high resolution, 3D image of the back of the mouth and throat, typically a difficult area to reach with conventional tools. With two robotically-guided instruments that act as a surgeon’s arms, tumors are able to be dissected free from surrounding tissue safely.

Pairing Surgery with Radiation

Most patients undergoing TORS for oropharyngeal cancer still need to receive radiation therapy. But since the tumor has been surgically removed, radiation doses are generally lower than for patients who receive combined chemotherapy and radiation regimens.

Ongoing Surgical Research at Johns Hopkins

Johns Hopkins surgeons are monitoring patients who receive TORS for oropharyngeal cancer with pre- and post-operative tests on swallowing, speech and quality of life. The results may help surgeons compare the outcomes of robotic procedures with more conventional ones.

Surgeons at Johns Hopkins are working with computer and bioengineering experts at the Johns Hopkins University to develop a robotic tool to improve surgeons’ access to the larynx (voice box). Head and neck cancer physicians generally use a flexible scope called a laryngoscope to access the voice box and other areas of the throat. Johns Hopkins experts are developing a robotic laryngoscope that can be used by thumbing a joystick with one hand. By threading a laser fiber optic line through the device, surgeons can remove tumors without using a scalpel in otherwise unreachable areas. They believe that such a device can also provide improved high resolution images of the throat, dexterity around corners, and required stability to use in operating room settings.

Scarless Surgery for Thyroid Tumors

To avoid a disfiguring scar across the neck from thyroid surgery, patients are turning to Johns Hopkins surgeons who are testing new techniques to remove the endocrine gland without a neck scar.

Young, healthy patients with select benign or suspicious lesions in the thyroid could be considered candidates for the procedures. Approximately half of all thyroid surgeries are done for benign or suspicious lesions. Patients with known cancers must undergo surgery via the neck because surgeons need to remove both sides of the thyroid gland and dissect lymph node tissue surrounding it.

In one procedure that was first developed in South Korea, surgeons enter through the axilla (or armpit) and use robotic arms extended under the chest to access the thyroid. Doctors say there a similar risk profile with this procedure, and patients retain good speech and swallowing ability.

Johns Hopkins surgeons will be monitoring outcomes of patients treated with the procedure. They are also studying the feasibility of removing the thyroid gland through the bottom of the mouth with robotic devices.