Region's First Transoral Robotic Surgery

Last summer, Baran Sumer, M.D., F.A.C.S., Assistant Professor of Otolaryngology and Head and Neck Surgery, performed the region’s first transoral robotic surgery (TORS) at UT Southwestern Medical Center. Since then, TORS has been used to successfully treat more than a dozen patients with head and neck cancer at UT Southwestern, giving patients the increased benefit of a minimally invasive, scarless procedure.

TORS is the latest application of the cutting-edge technology, as the usage of robotic surgery keeps expanding to new surgical specialties at UT Southwestern. Specifically, TORS has been applied to remove tumors from the oral cavity and throat, as well as to treat patients with sleep apnea.

“Compared to open surgery, TORS offers quicker recovery times, less blood loss, and fewer days in the hospital,” said Dr. Sumer, who completed a fellowship in transoral surgery for head and neck cancer at Washington University in St. Louis, in addition to receiving special training for the Medical Center’s da Vinci robotic system and TORS.

The da Vinci robotic system is one of four advanced da Vinci systems currently used by UT Southwestern physicians. Tools attached to the da Vinci robot remove tumors through the mouth, without any external incisions.

Removing tumors robotically involves use of a high-definition, 3-D camera attached to an endoscope for precise, magnified visualization, and small robotic instruments attached to the robotic arms. The surgeon controls the robotic camera and arms from a nearby console; the robotic arms and instruments precisely match the motions of the surgeon’s hands, while an assistant remains at the patient’s side to help the surgeon. A second console is available for two surgeons to work as a team.

“We have had excellent results since we adopted the da Vinci system for these types of operations,” said Dr. Sumer. “You can get fantastic visualization because of the ultra-bright illumination and magnification from the camera. The 3-D, high-definition view allows for more precise excision of these cancers.”

For patients, TORS offers tremendous advantages: no scarring or disfigurement; less time in the operating room, under anesthesia, and in the hospital; quicker recovery time; and fewer complications, infections, and blood transfusions.

“It’s an excellent option to be able to offer patients with head and neck cancer,” said Dr. Sumer.

Looking ahead to future advances, Dr. Sumer is currently collaborating with Jinming Gao, PhD, Professor of Oncology and Pharmacology in the Harold C. Simmons Cancer Center, to conduct research on the use of nanoparticles to deliver imaging and therapeutic agents to tumors of the head and neck and to further improve intraoperative tumor visualization and therapy. Dr. Gao’s lab pioneered the development of pH-activated nanoprobes that stay dark and invisible in blood but can be turned on in targeted tumor cells to improve tumor detection. These fluorescent nanoparticles have improved tumor detection in mice.

“We’re trying to develop nanoparticles that will improve the robotic surgery,” said Dr. Sumer.

This research, along with other clinical trials for patients with head and neck cancer, currently is taking place at the Simmons Cancer Center, which is the only cancer center in North Texas designated by the National Cancer Institute.

Head and neck cancers account for 3 percent to 5 percent of all cancer cases, affecting more than 650,000 people per year worldwide.