Dentistry focus: Oral cancer and surgical robots

A robot that is precise enough in its movements to remove cancerous tumours in the mouth and throat is being used by surgeons in the US.

Surgeons at University of Rochester Medical Center in New York are incorporating a surgical robot into their everyday practice more and more.

The first trans-oral robotic procedure in upstate New York – a partial glossectomy – was performed last year by surgeon Matthew Miller.

This procedure expands the medical centre’s robot-assisted surgery capabilities to include procedures for head and neck, urologic and gynecologic conditions.

The surgeon manipulates the robotic ‘hands’ in real-time using master controls, seeing minute, 3D details inside the patient with the aid of the cameras located inside the patient


Matthew explains: ‘Traditional approaches to these tumours have the potential to be invasive and disfiguring – often leading to an extensive recovery and rehabilitation period. The robot allows us to limit or even eliminate some of the side effects associated with more invasive surgeries while still effectively treating the cancer.

‘It offers greater visuals and flexibility in getting at tumours that are very hard to reach. The 3D visuals are so much better and the instruments give us 360-degree manoeuvrability, which means we’re able to perform surgeries with greater precision than ever before.’

Strong Memorial Hospital’s daVinci Surgical Systems consist of robotic arms that replicate a surgeon’s motions in real time.

The movements are by a surgeon using high-definition images provided by cameras positioned within the patient’s mouth.

The surgeon works from a console across the room from the patient.

Traditional surgery for some head and neck cancers requires large incisions – extending from the lip, across the chin and to the neck before entering the mouth or throat.

Often, surgeons need to cut through the lower jaw and move aside vital cranial nerves to gain access to the back of the mouth and throat.

Using the high-precision robotic system, surgeons insert the slender instruments into the mouth to reach the base of the tongue, tonsils, oropharynx and throat.


Matthew Miller

The benefits for people with head and neck cancers are dramatic because the surgeries can be done, primarily, without incisions and offer faster recovery time and a reduced risk of infection or other complications. The jaw is left intact and the cranial nerves are avoided.

‘Unfortunately, therapies for head and neck cancers haven’t offered any significant increase in survival over the past several decades. Yet our ability to improve our treatments – through surgical advances such as robotics, targeted radiation therapy and better chemotherapies – has had a dramatic impact on the quality of our patients’ lives,’ says Matthew Miller, assistant professor of otolaryngology and the James P Wilmot Cancer Center.
Robotic surgeries
The volume of robotic surgeries has risen dramatically in the past decade as demand for the minimally invasive approach grows and surgeons grow more comfortable with the technology.

The Medical Center is creating a Center for Robotic Surgery and Innovation to expand the use of robotic technology at Strong Memorial Hospital and expand research into its use.

The centre will also provide hands-on education for doctors who want to specialise in robot-assisted surgeries and use techniques honed by our surgeons.

During a robot-assisted surgery using the daVinci Surgical System, patients are positioned as they would be during laparoscopic surgery, with medical personnel surrounding them, yet a surgeon is located at a console a few feet away, supporting surgical team members install the correct instruments, and supervising the laparoscopic arms and tools being used.

The instruments are designed with seven degrees of motion that mimic the dexterity of the human wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation.

Although the surgeon is not physically in contact with the patient, the daVinci control console allows the surgeon to actually see the surgical field in enhanced detail as a result of the 3D image transmitted from the laparoscopic cameras.

The surgeon manipulates the robotic ‘hands’ in real-time using master controls, seeing minute, 3D details inside the patient with the aid of the cameras located inside the patient.

The two robotic arms and one laparoscopic arm execute the surgeon’s commands.
How it works
Minimally invasive da Vinci Surgery is routinely used to treat throat cancer. Throat cancer occurs in the larynx and pharynx, which includes the base of the tongue and tonsils. Throat cancer often develops from squamous cells (flat, thin, scale-like cells) on the moist tissue lining of the larynx, pharynx or mouth.

Worldwide, about 250,000 cases of throat cancer are diagnosed each year.

Tobacco and alcohol use are the leading risk factors for throat cancer: Those who use both have up to 100 times the risk of people who avoid both.

HPV (human papillomavirus) infection is the third major risk factor for throat cancer; oral cancers related to sexually transmitted HPV infections are rising in young adults in the US and here in the UK.

Traditional open surgery to treat throat cancer can be traumatic, disfiguring and result in difficulty speaking and swallowing.
da Vinci Surgery
State-of-the-art da Vinci Surgery provides surgeons with superior vision, precision, dexterity and control needed for delicate and complex procedures. da Vinci Surgery is performed minimally invasively – eliminating the need for a long incision and potential disfigurement. da Vinci offers patient many potential benefits when compared to traditional treatment options, including:
• Minimal blood loss
• Minimal pain
• No tracheostomy needed (incision in front of neck to provide airway)
• Low risk of complications
• Short hospital stay
• No visible scarring or disfigurement

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