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Canada's First Robotic Laryngectomy Performed

In a ground-breaking new achievement, doctors have been able to perform a throat surgery in Canada without cutting the patient.

Robotic surgery has been used to remove cancer from a patient's voice box for the first time in Canada, raising the prospect other Canadians with head and neck cancer can soon undergo surgery with fewer complications.

Doctors Kevin Fung and Anthony Nicholas, fresh from a week-long robotic surgery training course at the University of Pennsylvania, performed the minimally invasive laryngectomy using the da Vinci surgical system on Dec. 3.

A 72-year-old retiree recently became the first Canadian to have throat cancer removed by a robot in a procedure conducted at the London Health Sciences Centre in southern Ontario. He was glad to be one of the first people to be operated upon by this new technology. He was previously told that the cancer was incurable and that he could not get rid of it. This was a good opportunity for him and he surely benefitted from it. Normal hospital stays after traditional, open throat surgery last about two weeks, so Legere said he didn't hesitate when offered the chance to be guinea pig for the surgery in Canada

After a subsequent surgery to have his lymph nodes removed, the patient Gildard Legere has since been declared cancer-free.

In an interview from London, Dr. Yoo explained that the combination of robotic arms and three-dimensional, high-definition video allows surgeons to feel as though they are standing inside the patient's mouth.

Considering the robot can actually work around right-angle corners, he said surgeons are able to operate on areas that are practically impossible to reach. Add the fact that the robot can not only steady the surgeon's hand, but can scale her movements, and Yoo says it's an invaluable tool for experienced surgeons who specialize in cancer.

"The arms and the cameras can be actually placed right within an area of the body that would not otherwise be visible. Therefore, it allows you to remove the cancer directly that would otherwise not be available to be seen by the surgeons," Yoo said.

Throat surgery is considered a four-handed operation, with one surgeon cutting and the other sitting at the patient's head, working the mouth retractor and the suctioning.

The DaVinci robot provides three thin arms holding a camera and two surgical tools. A surgeon sits at a separate console looking into an eyepiece resembling binoculars. The doctor puts his or her hands into an apparatus, which then mirrors the movements of the fingers.

Even better, it can scale movements down for higher precision, reacting by, say, one centimetre for every four centimetres a surgeon moves. And it eliminates hand tremors.

According to the chief of the Otolaryngology Department at LHSC, the initial operation's success points to more similar procedures in the future.

"This is just a beginning, but I do see that this will be potentially a paradigm shift for many patients with cancer," Dr. John Yoo told CTV's Canada AM on Tuesday morning.

By removing the cancer outright, he explained, patients can often skip the debilitating course of radiation and chemotherapy that might be doctors' only other recourse.

Besides eliminating the need for major neck and throat incisions, the procedure is cheaper, reduces hospital stays and doesn't dramatically alter the voice. It also allows patients to forgo the discomfort of a post-op feeding tube. Legere, for example, was reportedly eating chocolate pudding the day after his surgery.

But Yoo warns that a relatively select few patients are candidates for the surgery at this time.

"We are targeting patients where the tumour itself is readily removable," he said, noting patients must be able to open their mouths wide enough for the robot's three thin arms.

"So these are relatively selective patients who have small tumours that we're targeting right now."

The London Health Sciences Centre has used surgical robotics for a variety of procedures including double-bypass surgery since they were first introduced in 1999. Since its initial robot-assisted throat surgery in December, the LHSC has performed another and have two more planned.

"There is an ever-increasing incidence of the kinds of cancers where robotic surgery could be applicable," Yoo said. "I think the application the robot will increase over time."


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