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Robotic Surgery Technique Treats Previously Inoperable Head and Neck Cancer

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The robotic arm moves directly through the mouth.
Graphics courtesy of the UCLA Department of Head and Neck Surgery

UCLA researchers have developed a robotic surgical technique to successfully access a previously unreachable area of the head and neck and safely remove tumors that may in the past have been considered inoperable or that required the use of highly invasive surgical techniques in combination with chemo or radiation therapy.

“This is a revolutionary new approach that uses highly advanced technology to reach the deepest areas of the head and neck,” the parapharyngeal space, says Abie H. Mendelsohn, MD ’06 (RES ’11, FEL ’11), director of head and neck robotic surgery. “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 no side effects.”

The parapharyngeal space is a pyramid-shaped area that lies near the base of the skull and connects several deep compartments of the head and neck. It is lined with many large blood vessels, nerves and complex facial muscles, making access to the space via traditional surgical options often impossible or highly invasive, such as splitting the patient’s jaw bone or areas close to the voice box.

The technique, transoral robotic surgery (TORS), was approved by the U.S. Food and Drug Administration in 2009. It utilizes the Da Vinci robotic surgical system; the surgeon operates with a three-dimensional, high-definition video camera and robotic arms that can navigate through the small, tight and delicate areas of a person’s mouth without the need for external incisions. A retraction system allows the surgeon to see the entire surgical area at once.

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Under guidance of the surgeon, the robotically
controlled instruments are able to take out only what is absolutely necessary, removing the tumor but leaving vital organs and tissues untouched.

Over the course of the robotic program’s development, Dr. Mendelsohn refined, adapted and advanced the TORS technique to allow surgical instruments and the 3-D imaging tools to at last reach and operate safely within the parapharyngeal space and other recessed areas of the head and neck. Dr. Mendelsohn’s new procedure largely benefits patients with tumors located in the throat near the tonsils and tongue, but it continues to be adapted and expanded in scope and impact.

“We are tremendously excited about the possibilities for the surgical community with this new advancement of TORS,” Dr. Mendelsohn says. “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.”

“Transoral Robotic Assisted Resection of the Parapharyngeal Space,” Head and Neck, February 2015



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