The robot will see you now
SURGEONS HAVE developed advanced techniques using robots to improve patient outcomes without compromising on surgical standards of care, writes Paul Stimpson, consultant ENT/head and neck surgeon at Highgate Private Hospital, north London. Many surgical specialities have benefited, including urology, gynaecology, cardiothoracic surgery and gastrointestinal surgery.
HEAD AND NECK SURGERY Head and neck diseases may be complex and have significant effects on normal function, such as speech and swallowing.
In the past, tumours of the back of the tongue, throat and voice box were difficult to access for the surgeon. In some cases, patients required very large operations to gain safe access to the tumours and completely remove them.
This often led to a lengthy hospital stay and prolonged recovery time, with long-term speech and swallowing problems.
Using a robotic system to access throat tumours via the mouth (transoral robotic surgery, or TORS) enables safe access with excellent vision and may remove the need for large incisions through the neck and face.
Not all tumours are suitable, however and sometimes large operations are still required, or non-surgical treatment such as radiotherapy (with or without chemotherapy) may be offered instead.
SO A ROBOT DOES MY OP? Your surgeon is still a human being. The robot is controlled at all stages by an expert surgeon, via a console in the operating theatre, adjacent to the robot. The robot is essentially a very advanced tool to help the surgeon get a better view in tight spaces.
IS TORS OFFERED IN THE UK? The first TORS procedures took place in America but the technique has been adopted across the world. The results are excellent for selected tumours and research is ongoing regarding expanding its application. In the UK, several centres have started using TORS. It is available in London and your surgeon will be able to advise you on your suitability for a robotic procedure.
WHAT NEXT?
Robotic surgery is here to stay. In the head and neck, it has already been used for “scarless” thyroid procedures, snoring surgery and airway management. It is likely applications will grow. With more expertise in these novel treatment strategies, it is hoped patient outcomes will continue to improve. OTHER INNOVATIONS
CARDIOVASCULAR MAGNETIC RESONANCE IMAGING (CMR) This is a non-invasive technique, based on the same principles as magnetic resonance imaging but optimised for the cardiovascular system.
A CMR scan can investigate the structure and function of the heart and blood vessels, including how well they are working. It can assess things such as heart muscle disease, blood supply, age-related wear and tear of the heart valves or damage to the heart after a heart attack. Visualisation of blood vessels also provides great insight into the function of cardiovascular health.
CMR does not use ionising radiation and patients generally cope well with it. The Royal Free Private Patients Unit provides a comprehensive CMR diagnostic service and pays particular attention to personalising the scans, tailoring them to the problem being investigated. Each case is discussed with the referring physician, to ensure the CMR data best assists the diagnosis.
BONE-BINDING
When Bradley Passell damaged his elbow in a schoolboy game, he never thought the injury would plague him for the next 20 years. Besides preventing him from swimming — one of his favourite sports — the injury eventually forced him to give up his dream of becoming a chef. But after years of pain and a series of operations and treatment, 27-year-old Passell is finally on the mend and steadily regaining almost full use of his arm, following surgery to replace his damaged elbow.
Using the latest “bone-binding” technology, orthopaedic surgeon Simon Lambert carried out the operation at Spire Bushey Hospital, Hertfordshire. He explains: “The damaged surfaces of the elbow joint are