Advantages and complications surrounding transoral robotic surgery
Prof Neil Gross - The University of Texas MD Anderson Cancer Center, Houston, USA
My interests are in transoral robotic surgery and clinical trials related to those. So my talk at this meeting is specifically on potential pitfalls of TORS and avoiding complications.
What are some of the pitfalls you’ve faced?
The most worrisome is bleeding afterwards. Unlike surgery in other parts of the body, say on your arm, when the surgery is done the skin is closed, it’s stitched up. In the back of the throat you can’t do that so it’s left open, it’s raw and these patients have a risk of bleeding as the scab essentially falls off. So there are techniques that if you have done this a lot, like I have, that you learn and adopt to minimise that risk.
What are some of those techniques?
There are a lot of dissection techniques, ways to minimise deeper trauma. So robotic surgery is really dependent on visualisation of the tissue, that supplants haptic feedback – you can’t feel the tissues so maintaining good visualisation, a clean, dry field is very important. Then, in particular, management of the arterial blood supply is very important. So these patients generally need a neck dissection, which is an external procedure, and when that’s done ligating the branches of the carotid artery that supply the wound area is important to prevent catastrophic bleeding later.
What are some of the advantages of this procedure?
This approach, transoral robotic surgery, avoids splitting the jaw for access, that’s the big advantage over traditional approaches. It also can be incorporated into a multidisciplinary approach whereby patients who have surgery may be able to receive a lower dose of radiation or no radiation or avoid chemotherapy after treatment. So there are potential advantages, even against other non-surgical treatments.
Do you think this will become standard practice soon?
It is going to be, I think robotics are going to expand significantly in surgery in general and in oncology in general. I liken it to the first generation cell phones that were kind of clunky and not very useful; technology is really advancing very quickly and it will enable us to have much more minimally invasive approaches to diseases compared with the past. There’s already a strong rationale to use it now and it’s here to stay, I would say, but that’s only going to increase over time.
What is your key point?
I think there is a lot of excitement for the role of robotic surgery in head and neck cancer and I see that expanding in the future but there is a learning curve to it and there are risks. So it needs to be adopted with caution and training is important to avoid complications down the road.