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Physician Update - New Reach for the Robot

Physician Update Spring 2010

New Reach for the Robot

Date: May 1, 2010

Surgical teams are advancing with smaller incisions in head and neck procedures


Jeremy Richmon
Jeremy Richmon says surgeons are making advances in deploying robotic devices in head and neck procedures.

When a surgical robot first entered the minimally invasive surgery scene in the late 1990s, it quickly became the preferred tool for operating on patients with prostate conditions. Over time, it’s made its way into other fields, including bariatric and gynecologic surgery, to name a few. But for the minimally invasive procedures performed by head and neck surgeons, robotic surgery proved far trickier.

That, says Johns Hopkins head and neck surgeon Jeremy Richmon, is changing.

The problem with using the robot for head and neck tumors had been that the “arms” of the machine—used to manipulate surgical instruments—are too large to maneuver through the mouth, which is the preferred minimally invasive method for reaching tumors of the upper aerodigestive tract.

“The robot wasn’t designed for this,” Richmon explains. “It was designed for operations on the prostate and abdomen,” which are usually performed by fitting the robotically controlled surgical instruments and viewing devices through several widely spaced openings in the body at once.

Today, however, surgeons have found ways to overcome the obstacles presented by the narrow spaces in the head and neck, and Johns Hopkins is now among a handful of centers across the country approved to use the robot for transoral procedures.

“We’re the only center in Maryland that does this,” Richmon says, “and one of just a few on the East Coast.”

Minimally invasive procedures are especially beneficial in treating head and neck conditions, which have often required large incisions (and the deeper and less accessible a tumor or lesion, the more invasive the treatment might need to be).

“The goal,” Richmon says, “has always been to develop surgical approaches that are less invasive than traditional ones and to decrease the morbidity of going through other areas of the head and neck and making large incisions.”

With the robot, he adds, “because we fit everything in through the mouth, what we’re doing is a new application of existing technology.”

Although some patients who undergo robotic surgery may also require radiation and chemotherapy, Richmon expects the need for such treatments to decrease in some cases. The risks of swallowing and speech problems may also be lessened.

“This is a novel approach to treating tumors of the tonsil and base of tongue,” he says. “We’re following these patients very carefully for functional and long-term outcomes. So far, they’ve all recovered exceptionally well.”

Call 410-955-6420 to refer a patient.

http://www.hopkinsmedicine.org/otolaryngology/our_team/faculty/richmon.html

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