The da Vinci robot is well regarded for prostate, cardiac, lung, and other surgeries of the chest and mid-section of the body. Recently, doctors at UAB have been working with a new application of the robot, operating on the narrow spaces inside the head and neck. “Doctors in Pennsylvania pushed this first and really developed this,” said William Carroll, MD, head and neck surgeon with UAB’s Division of Otolaryngology. In fact, researchers from the University of Pennsylvania School of Medicine’s Department of Otorhino-laryngology/Head and Neck Surgery completed several studies that demonstrated the efficacy of the new procedure. In one study, operating on a mannequin, researchers found that by applying simple instruments commonly used for a tonsillectomy, the robotically controlled camera and surgical instruments could be inserted through the mouth into the throat and voice box. Impressed with the research, UAB doctors began work in the area. UAB was one of the first medical centers in the United States to use the da Vinci for head and neck cancers, and thus far, 40 UAB patients have had the operation. “This application takes robotic surgery to new places in the body,” Carroll said. “But the ability to do robotic surgery on head and neck tumors depends on being able to see in the areas where we want to work.” Some patients are not good candidates because the patient’s own anatomy, the shape of their teeth, mouth or jaw, inhibits access. Before UAB could begin using the da Vinci robot for head and neck cancers, it had to adapt operating techniques and the robot-arm positions, and continually refine those adaptations. Though the narrow spaces inside the head and neck can be a challenge, the tiny cameras attached to the end of the da Vinci instruments offer a magnified, 3-D image that gives surgeons a greater field of vision than conventional open or laparoscopic surgery. “The idea is that you go in and accomplish the surgical procedure with the least amount of destruction to normal surrounding tissue, so you cause less side effects,” Carroll said. Traditional cancer surgery can consist of an almost ear-to-ear incision across the throat or splitting the jaw in half, which can result in speech and swallowing deficits for patients. Results show that on average the new procedure leaves less scarring, breathing problems and damage to speech. Carroll says that the robotic surgery patients usually leave the hospital in two to three days as opposed to the seven to ten days following the traditional, open surgical procedure. “They go home without a lot of extra tubes and appliances to help them in the early post operative period. They’re able to resume diet and get back with their families in shorter time,” he said. “Less pain. They’re recovering much more quickly.” “The robotic surgery offers us an option to get rid of the cancer as effectively as the open traditional surgery or a six- to eight-week round of chemo-radiation, but leave them with less side effects,” Carroll said. This year, more than 40,000 Americans will be diagnosed with head and neck cancer, which includes cancers of the oral cavity, the larynx and the pharynx, and more than 7,500 will die from the disease. “The overall survival rates are 55 to 60 percent,” said Carroll, who emphasized that if the cancer is caught earlier, the survival rate jumps to 85 to 90 percent. He said that most patients ignore early warning signs — lasting pain or hoarseness, a lump in the neck, a sore in the mouth, a chronic cough — because they fear intrusive and expensive exams to assess the situation. “Most of the time we can just look in the mouth and throat and feel the neck and reasonably reassure the patient that nothing really worrisome is going on,” he said. He encourages physicians to inform patients about the signs, especially patients with a high risk factor, such as those who consistently have used tobacco or alcohol over a number of years. “We’d like to pick patients up at an earlier stage.” He noted that the HPV virus has also been noted to play a role in this cancer. “It will be interesting to see if the new HPV vaccine available to prevent cervical cancer impacts the head and neck cancer,” he said. June 2008