Tumors found deep within the head and neck were previously considered to be either inoperable or treatable only with highly invasive surgical techniques. However, thanks to the development of a groundbreaking new surgery method, such concerns could be a thing of the past.The pioneering method makes use of a minimally invasive procedure known as Trans Oral Robotic Surgery (TORS), during which a specially trained physician performs surgery while controlling a surgical robot, complete with robotic “arms” and a 3D, high-definition video camera.

TORS has been adapted and refined by Dr. Abie Mendelsohn from the University of California, Los Angeles (UCLA), and utilizes the state-of-the-art Da Vinci robotic system, also developed at UCLA. “Patients can now be treated in a manner equivalent to that of a straightforward dental procedure and go back to leading normal, healthy lives in a matter of days with few or even no side effects,” says Dr. Mendelsohn, director of head and neck robotic surgery at UCLA.

This is a remarkable change in prospects for many patients who previously would have little or no hope of living cancer-free lives. Surgery previously ‘impossible or highly invasive’ TORS can now be used to operate within the parapharyngeal space – a pyramid-shaped area situated near the base of the human skull. It is particularly difficult to access with traditional surgical methods, as the space is lined with many large blood vessels, nerves and complex muscles.

When traditional surgical access to this area is possible, it is often highly invasive. External incisions to the neck or splitting the jaw bone can be required, not to mention the use of chemotherapy and radiation therapy, resulting in a more complicated recovery with potentially serious side effects. “They described a procedure where your face is split in half and it’s basically reconstructive surgery. I was completely freaked out,” says David Alpern, diagnosed with throat cancer in 2012. Fortunately for David, he was identified by Dr. Mendelsohn as a perfect candidate for TORS.

TORS was first approved by the US Food and Drug Administration (FDA) in 2009, but only now can it reach and operate safely within one of the most inaccessible parts of the human body. Controlled by the surgeon, the robotic arms navigate through the tight and delicate areas of the mouth without necessitating any external incisions. The surgeon works from a console near the patient’s bed, with every movement of their hands controlling the surgical instruments. Using a retraction system, they can also see the entire area of surgery.

David Alpern underwent TORS and had recovered from the procedure only a few days later. His tumor was successfully removed and he is now cancer free, as are more than 100 other patients following similar TORS procedures with Dr. Mendelsohn. Potential for expanding the scope of the treatment At present, the new method is of the most benefit to patients who develop tumors in the throat near the tonsils and tongue, though Dr. Mendelsohn says he hopes to develop TORS further:

“We are tremendously excited about the possibilities for the surgical community with this new advancement of TORS. Now patients have options they never had before, and we can even develop potential applications for the procedure beyond the surface of the head and neck.”

A report describing the operative technique can be found in Head & Neck. In this paper, Dr. Mendelsohn writes that future publications involving clinical outcomes will be needed in order to show how effective this new minimally invasive approach is.

The new method may have already made a real difference to the lives of hundreds of patients like David Alpern. “I try not to get too cocky or excited that I beat cancer, but I think I did. There are no side effects at this point,” he says. “My hopes are just to watch my kids grow up and enjoy my family and my life.”

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