Robotic-assisted surgery has a potential use not only for treating benign and malignant tumors, but also for treating inflammatory conditions such as chronic lingual tonsillitis in the back of the tongue. When a patient complains of chronic tongue base tonsillitis that does not respond to antibiotics, it is a real problem for the patient and the surgeon, Dr. Weinstein said. It is very difficult to remove the tongue base tonsils using standard techniques. At the University of Pennsylvania, preliminary studies in a few patients suggest that robotic-assisted surgery takes only about 15 minutes to remove the tongue base tonsils, and no further infections have been seen with long-term follow-up.
Dr. Weinstein and his group conducted a study using robotic-assisted surgery to perform radical tonsillectomy in 27 patients with tonsil cancer; a review of these cases was presented in April at the Combined Otolaryngology Spring Meeting. Most of these patients would have been treated with chemotherapy and radiotherapy, which, studies suggest, may have a negative impact on swallowing function. At six-month follow-up, only one of these patients had swallowing difficulty. Robotic surgery allowed surgical staging and avoidance of chemotherapy and radiotherapy with their attendant side effects in approximately half of these patients, all of whom had good swallowing function, he said.
Although long-term oncologic and functional results still need to be evaluated, to date there have been no cancer recurrences in this group.
It’s too early to determine whether oncologic outcomes will be similar to those achieved by chemotherapy and radiotherapy. The hope is that robotic-assisted surgery can preserve function with equally good oncologic outcomes, he said.
Another potential application of robotic surgery may entail transaxillary approaches to the thyroid, said F. Christopher Holsinger, MD, Assistant Professor of Head and Neck Surgery at the M. D. Anderson Cancer Center in Houston. Dr. Holsinger attended a course in robotics techniques last year that was offered at University of Pennsylvania. A study to assess functional outcomes in TORS is now pending IRB approval at M.D. Anderson.
Benefits to Patients
The benefits of TORS are numerous, according to surgeons interviewed for this article.
Some tonsil- or tongue-based cancers require large, complex, long operative procedures involving tracheostomy, complex skin reconstruction, and splitting the jaw, Dr. Weinstein explained. Blood transfusions are often required for these large open procedures. Only one patient who underwent TORS at the University of Pennsylvania required a blood transfusion, he commented.
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