Head and neck surgeon
Jeremy Richmon hopes to
adapt current robotic technology
to suit his patients.
When surgical robotic technology 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, gynecological and cardiovascular surgery, to name a few. But for the minimally invasive procedures performed by head and neck surgeons, robotic surgery has proven tricky.
That, says head and neck surgeon Jeremy Richmon, could soon change.
The problem with using the robot for head and neck tumors is that the “arms” of the machine—used to navigate surgical instruments—are too large to maneuver through the mouth, which is the preferred minimally invasive method for treating tumors of the upper aerodigestive tract. “The robot wasn’t designed for this,” Richmon explains. “It was designed for surgeries of the prostate and abdomen,” which are usually performed by fitting the robotic arms through multiple openings in the body at once. So far, he says, a handful of other centers across the country have successfully pioneered methods of using the robot for trans-oral surgeries. Now Hopkins hopes to take the lead.
Minimally invasive procedures are especially beneficial in treating head and neck conditions, which have often required large incisions to perform surgeries that, using a robot, could be done through the mouth or nose. Meanwhile, the deeper and less accessible a tumor or lesion, the more invasive the treatment might need to be. “The goal is to develop surgical approaches for the head and neck that are less invasive than traditional ones,” Richmon says, “and to decrease the morbidity of going through other areas of the head and neck and making large incisions.”
Richmon and his colleagues have already successfully tested robotic techniques in cadaver and other models, and are awaiting approval to perform the procedures in clinical practice. “Because we’re trying to fit everything in through the mouth,” Richmon says, “what we’re doing is a new application of existing technology.” But, he continues, there is a potentially superior option that he and his colleagues, along with researchers in the Johns Hopkins University Whiting School of Engineering, are developing. Together, the team is devising new technology that will be more appropriate for head and neck surgeries than the robot available today.
The greatest challenge with the current robot, Richmon explains, is the rigidity of its arms, which makes it difficult to maneuver around the corners and narrow passages between the mouth and the tumor site. To overcome that obstacle, Richmon and his collaborators are developing bendable, snakelike arms as an alternative.
Even without yet having perfected such modifications, Richmon says, “we’ve been able to use the existing robot to reach tumors that otherwise would have required large incisions. Our goal is to come up with even better approaches, and we would like to be one of the first centers that really pushes this to the forefront in the United States.”