Innovative Minimally Invasive Techniques for Head and Neck Cancer

Drs. Ghassan J. Samara and Mark F. Marzouk, Ear, Nose and Throat (ENT) surgeons, in the Division of Otolaryngology-Head and Neck Surgery, discuss two innovative minimally invasive techniques—robot-assisted surgery for ENT procedures and salivary endoscopy—and how this benefits patients with cancer and other disorders.

What is the role of robot-assisted surgery for ENT procedures?

Although robot-assisted surgery has been used for heart, gastrointestinal, urinary, gynecologic and other surgeries over the past decade, only recently has it become available for ear, nose and throat surgery. The high-tech robotic platform employed by Stony Brook is called the da Vinci^® S HD^TM Surgical System. Basically, it allows doctors to insert a 3D telescope five to eight millimeters in size through the mouth. This gives excellent visibility, access and magnification of areas that in the past were unreachable with surgical instruments. Physicians can use it to diagnose and treat cancers of the mouth, throat and tongue, remove tonsils with little or no blood loss, treat sleep apnea and perform microsurgery in areas that were previously inaccessible. In the past, ENT surgeons needed to cut through the jawbone, lips or neck to open up the throat, so this procedure offers a huge advantage to patients in terms of minimizing blood loss, pain and recovery times. It also gives surgeons an unprecedented perspective—almost as if you were standing inside the throat or mouth itself. The magnification is so great that not only do you see things much clearer, you also see things you never saw before.

What is salivary endoscopy and what is it used for?

Salivary endoscopy is a minimally invasive technique that allows us to examine the salivary ducts (the place where saliva passes from the salivary gland into the mouth) through an endoscope and make a diagnosis. At the same time, we also can perform treatment; for example, removal of stones from the salivary gland (sialolithiasis), duct dilation and steroid injection, or removal of scar tissue caused from radiation or chemotherapy used in thyroid cancer treatments. This is ideal for patients because they do not need multiple procedures and it can be done on an outpatient basis. Previous treatment involved surgical removal of the entire salivary gland, which entailed an incision in the neck and an overnight hospital stay. This new procedure is most frequently used for sialolithiasis—something that affects approximately 12 in 1,000 adults. Salivary endoscopy spares the gland without risk to vital structures such as the tongue and facial nerves. Recovery time is also faster than with the previous open surgical technique, and patients may return to a normal diet the same day. Current literature reports the success rate of these procedures at 90 percent, with a less than 5 percent recurrence.

Where are these minimally invasive techniques available?

In Suffolk County, only at Stony Brook University Medical Center. The first salivary endoscopy procedure was performed in October 2010, and to date, more than five patients have benefitted from it. As for the robot-assisted surgery, fewer than 100 surgeons worldwide have been trained on the equipment, and there are just a few in New York State. Both of these techniques improve the patient experience, promoting faster healing and a return to normal activities.

Are there other breakthroughs that can benefit patients?

Yes, RapidArc^® is a radiotherapy technology that is being used at Stony Brook for patients with head and neck cancer and is among the most advanced forms of intensity modulated radiation therapy. RapidArc delivers beams two to eight times faster than conventional radiotherapy, so patients do not have to hold still for long periods of time. This, in turn, makes patients more comfortable and improves the quality of care. There is also less of a chance that patients will shift or move, so the radiation is more highly targeted. This precision of delivery means that the radiation goes to where it is needed—the tumor—and not the healthy tissue surrounding it. As a result, patients tend to have less intense side effects associated with treatment.

For more information about head and neck cancer, call (631) 444-4000 or visit StonyBrookCancerCenter.org.

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