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 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.