Hollings Cancer Center surgeons introduce da Vinci single port robotic system in South Carolina for head and neck cancer care

Doctors with MUSC Hollings Cancer Center are the first in South Carolina to perform head and neck cancer surgery with the da Vinci SP, a single port robotic system.

The new system gives patients more options for care, particularly patients with HPV-related cancers that are often caught at early stages and can be treated with surgery.

“It really has revolutionized our ability to treat this area,” said Alexandra Kejner, M.D. She was the first head and neck surgeon in South Carolina to use the new robot, though it wasn’t her first outing with the system. She was also the first to use it in Kentucky and agreed to join MUSC Health last year only with the promise that a da Vinci SP was on the way.

“It’s like dial-up compared to broadband,” she said, comparing the robot previously in use to the new one.

W. Greer Albergotti, M.D., who has also now used the system, called it a “huge advancement.”

"It gives us a much closer, magnified view of the tumor and the surrounding normal anatomy that we want to make sure to avoid. Overall, it’s a leap forward for the quality of surgery that we're able to provide to patients in South Carolina."

W. Greer Albergotti, M.D.

“It gives us a much closer, magnified view of the tumor and the surrounding normal anatomy that we want to make sure to avoid,” he said. “Overall, it’s a leap forward for the quality of surgery that we're able to provide to patients in South Carolina.”

In robotic surgery, “ports,” or incisions, are made to insert the robotic instruments and camera into the surgical area – in the head and neck this means the mouth, without any external incisions. The surgeon then controls the instruments from a console rather than standing over the patient. Previously, surgeons used a robot that had three arms – one for a camera and two for instruments. That’s a lot to fit in someone’s mouth, Kejner pointed out, and it wasn’t feasible for every patient or every tumor. In addition, the camera was attached to a rigid endoscope. It could move forward or backward, but it couldn’t snake around the contours of the throat.

The da Vinci SP single port system uses only one arm, and the instruments and camera all emerge from that single arm. In addition, the camera is on a flexible endoscope that the surgeons can manipulate to look up, down and around.

 

“The SP really has changed our ability to access areas of the oropharynx (throat), the hypopharynx (lower throat) and the larynx (voice box). ...It's given us the ability to get to tumors on the back of the tongue and adds to a patient’s ability to choose treatment modality."

Alexandra Kejner, M.D.

“The SP really has changed our ability to access areas of the oropharynx (throat), the hypopharynx (lower throat) and the larynx (voice box), and some people are also starting to look into using it in the nasopharynx (back of the nose),” Kejner said. “The other thing that we're able to use with these is a laser so you can put a laser fiber into the robot’s hand with this and utilize it to do resections.

“It's given us the ability to get to tumors on the back of the tongue and adds to a patient’s ability to choose treatment modality,” she added. Previously, access to this area involved cutting through the jawbone, requiring much longer hospital stays and recovery time. Such extensive surgery typically wasn’t recommended, given other options, including chemotherapy and radiation.

She anticipates that the system will be especially useful for patients with HPV-caused cancers. These patients tend to be younger and are likely to do well after treatment, she said, and they may want to avoid potential long-term side effects of other types of treatment, like radiation. Additionally, the system can be used as salvage surgery for patients for whom chemotherapy and radiation have failed and reduces the potential morbidity of larger, open procedures.

 

The choice of radiation, chemotherapy or surgery partly depends upon patient preference and partly on the likelihood of success and quality-of-life effects of each method. Now, Albergotti said, surgery is an option for more people.

"We're seeing a lot more of these cancers that are HPV-related, either in the tonsils or back of the tongue,” he said. “They can be treated with either radiation or surgery, but we think that a significant number of patients are better served with surgery, from a long-term outcome standpoint.”

Because these cancers would have been treated with non-robotic surgeries in the past, which come with longer recovery times and more risks, patients tended to be treated with radiation instead, he said, and that viewpoint still prevails.

“Even now, we know a lot of patients are not referred for consideration of surgery,” he said. “There's a sense with a lot of doctors in the community that radiation is still the standard of care. It is an option, but surgery is now an option as well.”

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