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For patients with cancer of the mouth and throat, surgery is a frequent course of treatment, often leading to speech and swallowing dysfunction and external scarring. Researchers from the University of Pennsylvania School of Medicine's Department of Otorhinolaryngology/Head and Neck Surgery, have completed two studies ?the most comprehensive and largest to date ?that demonstrate the effective use of the daVinci Surgical Robotic System to perform Trans-Oral Robotic Surgery (TORS) which greatly reduces surgical trauma for patients. Their initial findings will be presented Monday, May 16th at 11:45 a.m., at the combined annual meetings of otorhinolaryngology (ear, nose and throat) experts ?the Triologic Society, May 13th through16th, in Boca Raton, Florida.

PENN physicians anticipate that the application of the daVinci System to treat mouth and throat cancers will allow for complete tumor removal while helping to preserve voice and swallowing function. "The daVinci Robot has been FDA-approved and successfully integrated into cardiac and urologic surgery. Patients are reaping the benefits with decreased bleeding, less pain, and are able to return to work sooner," said otorhinolaryngologist Neil G. Hockstein, MD, who served as lead investigator for both studies. "I saw the potential to apply the attributes of surgical robotics to the treatment of head and neck cancer and we've successfully devised novel approaches to introduce the robotic arms through the mouth into the throat and voice box."

For head and neck tumors, treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure. Conventional cancer surgery can consist of an almost ear-to-ear incision across the throat or splitting the jaw in half. This can result in speech and swallowing deficits for patients. "The research we've done to date suggests that TORS has great potential to improve the way we treat head and neck cancer patients," said Bert O'Malley, Jr., MD, Chair of PENN's Department of Otorhinolaryngology/Head and Neck Surgery. "We believe this technology will have a dramatic impact on the ability to completely remove tumors while preserving speech, swallowing, and other key quality of life issues."

In the first study, researchers used the daVinci Robot and "operated" on a mannequin. They found that, by applying simple instruments and retractors commonly used for tonsillectomy, the robotically controlled camera and instruments could be inserted through the mouth into the throat and voice box. The surgeons were able to manipulate different elements in the voice box with a high degree of dexterity that would be tremendously difficult using conventional instruments. They were also able to suture and tie knots deep in the mannequin's throat with relative ease ?a task exceptionally challenging without the aid of robotic technology.

In the second study, the surgeons performed a variety of surgical procedures on a human cadaver. They concluded that robotic surgery may shorten operating time and allow for minimally invasive treatment of more cancer patients.

The self-contained daVinci robotic system has three main components: a mechanical robot with three multi-jointed arms; a computer command center several feet from the patient, where the doctor sits, and a 3-D computer monitor similar to a "viewfinder" that affords a magnified view of the surgical site inside the patient. Equipped with a special, double-telescopic endoscope, the viewfinder allows surgeons to see the surgical site more closely than human vision allows, and to work at a smaller scale of detail than conventional surgery permits. Unlike other endoscopic systems now in use, which afford reverse-image views that require counter-intuitive movements by surgeons (whereby the surgeon must move his hand to the left in order to move the mechanical device to the right), the daVinci technology afford s surgeons the direct, "intuitive" control they exercise in traditional open surgical procedures, seamlessly translating their natural hand, wrist and finger movements at the console into corresponding micro-movements of laparoscopic surgical instruments inside the patient's body.

Additionally, the robot is computer controlled to eliminate any tremors and allow for steady, precise movements. "When operating with the daVinci System, the optics and fluidity of instrument movement are just amazing," adds Hockstein. "It has the potential to add great precision to our surgical treatment of a variety of diseases of the head and neck.



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