Oral cancer tends to affect otherwise healthy people in their 20s through 50s and is often in an advanced stage when diagnosed. Standard surgical approaches, chemotherapy, and radiation therapy are only moderately successful in treating oral cancer, and traditional surgery can involve splitting the jawbone open to fully access and remove malignancies.
This approach is associated with a lengthy hospital stay, difficulty swallowing, impaired speech, and extended feeding via gastric tube.
Transoral robotic surgery is a recent development in minimally invasive surgical techniques and offers improved cure rates and fewer complications. During the procedure, an assistant is positioned at the patient's head to provide suction or traction or other support. The surgeon manipulates controls inside a workstation console several feet from the operating table while looking though binoculars equipped with a high-resolution 3-D stereoscopic imaging system. These controls guide robotic instruments, including graspers and cautery instruments, docked at the operating table.
Surgical robots help overcome some of the challenges associated with conventional surgical procedures by allowing surgeons to operate with more precision and flexibility. The master controls at the surgeon's console relay the exact movements of the surgeon's hands and fingers to the instruments and filter out any hand tremor. The surgical instruments are equipped with articulating tips and wrist mobility that improve precision. This sensitivity enhances a surgeon's ability to navigate challenging anatomy, to deftly perform microresection, and to precisely place sutures.
When performed by experienced high-volume surgeons, the robotic approach provides an effective option for a wide range of patients. At Mayo Clinic, surgeons now use the robotic system to remove tumors from the tonsil, palate, base of the tongue, throat, and pharynx that are hard to access with other modalities.
A dedicated team of Mayo Clinic surgeons has developed a surgical technique using the robotic system. In 2009, Mayo surgeons studied a group of 45 patients with tonsil and base of tongue cancers to evaluate the safety and efficacy of the transoral robotic approach. Study participants included 26 patients who had base of tongue primary tumors and 19 patients who had tonsillar fossa tumors, all of whom underwent surgery using the robotic approach. Mayo researchers recorded data on surgical time, blood loss, surgical complications, tracheostomy tubes, feeding tubes and resumption of oral diet, speech, swallowing, and tumor recurrence.
No major complications occurred and no procedure was stopped due to inability to remove the tumor. The average hospital stay for these 45 patients was 2.3 days, while patients undergoing traditional oral surgery for the same diagnosis typically require 7 to 10 days in the hospital. Additionally, the removal of feeding tubes in patients undergoing robotic surgery occurred an average 7 to 10 days after surgery, while patients undergoing traditional surgery typically require 2 to 3 months of feeding tube use.
Mayo Clinic surgeons have now performed more than 100 transoral robotic surgeries and have adopted this procedure as their technique of choice for patients with tumors of the tonsil and base of tongue. They are also exploring the use of the robotic approach for the removal of voice box polyps and tumors in the larynx and other regions difficult to access through the mouth and for the treatment of obstructive sleep apnea and Zenker diverticulum.