Issue link: https://viewer.e-digitaledition.com/i/1004438
of surgeries that might benefit from a robotics approach. The fact that many surgical special- ists work in close proximity is a benefit, Dr. McCann says. "That's one of the more unique things about our program. Because we have all of the surgeons in the same place — as opposed to ot her centers where not everybody operates at the same hospi- ta l — it's not uncommon that three or four surgeons will combine efforts for one complicated case." TORS Among the advanced robotic proce- dures offered at University Hospital is trans-oral robotic surgery, or TORS. The primary application is to excise malignant oropharyngeal tumors arising from the tonsils or base of tongue. These cancers have been on the rise in younger men due to the human papillomavirus, or HPV, that causes cervical cancer in women. "The incidence of tonsil and base-of- tongue cancers is increasing in otherwise healthy patients who don't have the usual risk factors like heav y smoking a nd drinking," says Jay Ferrell, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery at UT Health. "We've seen a big jump in the rates of these HPV-related ca ncers over the last severa l decades." In years past, reaching these cancers required a la rge incision on the face or neck and complex open procedures that of ten requi red split ti ng t he jaw a nd cutting directly into the pha r ynx. That could lead to complications of spea king a nd swa llowing, requiring a tracheos- tomy a nd feeding tube for months or even yea rs. For the past 20 yea rs or so, radiation a nd chemotherapy have been the treatment of choice. "In contrast to traditional, smoking- related head a nd neck ca ncer, these HPV-related cancers respond very well to treatment , w ith high cure rates," Dr. Ferrell says. "However, the drawback is that these patients (with HPV-related ca ncers) a re younger a nd have much longer to live with the side effects of chemotherapy and radiation therapy, which can be potentially debilitating." Those side effects often include severe sore throat, skin changes and wounds, and, in extreme cases, damage to the muscles and nerves for speaking, swallowing and normal tongue movement. Robotic surgery allows the surgeon to access — and visualize — these hard-to- reach tumors. And by removing them, that can mean reducing the amount of chemotherapy and radiation patients receive afterward. "It's not for everyone," Dr. Ferrell says. "This is not for people who have very large tumors at the back of the throat or large lymph nodes and are going to need a lot of aggressive therapy. But in some of these younger, healthier patients who are caught pretty early with these cancers, it is a reasonable treatment option — and poten- tially can reduce the amount of radiation and chemotherapy they get." STOMACH Dr. Van Sickle and his colleagues use robotics for gastroesophageal reflux dis- ease (GERD), hernia repair, gallbladder surgery and other common procedures. Much less common is a robotic com- bination therapy for gastroparesis — a disabling condition most often seen in diabetic patients in which the stomach doesn't empty properly. Another less com- mon procedure they perform is robotic roux-en-Y gastric bypass surgery. "We've been able to combine two sur- gical therapies for gastroparesis in one procedure, and we've found it to be very effective in selected patients," Dr. Van Sickle says. "One is the implantation of a medical device called a gastric stimulator. It basically interrupts the signal from your stomach to your brain that tells you you're full and gives you that feeling of bloating and nausea. "The other procedure is called pyloro- plasty. It was widely used for peptic ulcer disease surgery in the 1960s and '70s. You cut the stomach's sphincter muscle and suture it back in such a way that it stays open. Between half and two-thirds of our patients see almost a complete resolution of their symptoms." As for roux-en-Y bypass, Dr. Van Sickle says the robot addresses the most common M D N E W S . C O M /// M D N E W S S A N A N T O N i O ■ 2 018 0 7