Single-Port Robotic Surgery Arrives at Huntsman Cancer Institute

Hilary McCrary, MD, MPH, a head and neck surgical oncologist and microvascular reconstruction surgeon at Huntsman Cancer Institute and assistant professor of otolaryngology at the University of Utah

Up until recently, select patients with oropharynx cancer in the Intermountain West had no choice but to seek care elsewhere if it was recommended they undergo surgery with a single-port robot. Now, the state-of-the-art technology, which has become standard at many centers across the United States, is available at Huntsman Cancer Institute at the University of Utah.

The single-port robot allows for precision surgical capabilities with novel instrumentation, such as changing shape to increase visibility around corners. Hilary McCrary, MD, MPH, a head and neck surgical oncologist and microvascular reconstruction surgeon at Huntsman Cancer Institute and assistant professor of otolaryngology at the University of Utah, mentioned that is beneficial for surgeons performing surgery on patients with cancer in the supraglottic region.

“Ultimately, we’re going to be able to see more patients, offer more precise surgery more efficiently, and that means just better outcomes for our patients here in the Intermountain West,” McCrary said in an interview with CancerNetwork.

In the interview, McCrary discussed bringing the single-port robotic surgery for patients with head and neck cancer to the Mountain West.

CancerNetwork: This is the first and only single-port robot in the Intermountain West for patients with head and neck cancer undergoing surgery. At baseline, how does this robot operate?

McCrary: We have been using the da Vinci Robot for several years for head and neck surgical oncology, specifically most commonly for oropharynx cancer. Over the years, the technology has rapidly improved. The single-port robot has now become the standard of care for robotic surgery and head and neck surgical oncology. What’s novel about the single-port robot is it has 1 single unit where all our instruments come out.

Traditionally, the old robots may have had 3 or 4 arms that all come in towards the patient. This has one single port where all our instruments, up to 4, can go through that. We commonly use 3 for these procedures.

There is a very novel camera that is part of this system. What’s novel about it is it can change shape to get around tricky corners, so that we can see some of these more complicated areas in the back of the throat, particularly at the base of the tongue or supraglottic larynx. Basically, it can go into a form called the "cobra pose" to allow us to be able to see around these tricky corners. The patient is turned 180 degrees, and we bring the robot in, position it, and then we bring the instruments into the oral cavity. Then we can manipulate those instruments to better and more accurately take out head and neck cancers in the back of the throat.

How do you envision the single-port robot having a significant impact on clinical practice for patients in this region?

The impact is that we’re able to offer better surgeries for patients who are suffering from both benign and malignant tumors at the back of the throat. For example, the first surgery that we did here at Huntsman Cancer Institute was for a benign base of tongue or molecular cyst mass that a patient had been suffering for several years and had undergone many prior excisions. With this advanced technology, we were able to offer a more definitive approach to his tumor. It will allow us to get more patients in a timelier fashion, we’re now able to schedule these surgeries on various days of the week, whereas we had more restricted time using the more traditional robotic systems.

There was an announcement about the 34-year-old patient who was going to undergo surgery with the single-port robot. How did the surgery go?

We had the surgery back at the end of January. His tumor was quite tricky in terms of exposure, but we were able to get a very nice resection, I’ve seen him since and he’s doing well. Without that technology, I think his tumor resection would have been extremely difficult because of how difficult that exposure was. Using this advanced technology and getting that advanced camera positioning allowed us to have an optimal outcome for that patient.

I used this same robot in fellowship, I had my Head and Neck Surgery Fellowship at Ohio State University. I used this same robot for a year, so I was able to take this training back to Utah. I’ve been helping get the robots established here at the Huntsman Cancer Institute. My colleagues here who also do robotic surgery, Drs [Richard B.] Canon and [Marcus M.] Monroe, have been doing this a long time, so it’s just a matter of showing them just how to set up the robot. It wasn’t necessarily novel for me to use the single port, but it was novel in the way that we’re able to now offer this in the Intermountain West. This has become the standard of care nationally for taking care of patients with oropharynx cancer. We’re all proud that we’re now able to offer that for patients here.

Does this also influence the quality of life for our patients?

The data show that before robotic surgery, we had to do some morbid surgeries, including mandibular splinting to get to tumors in the back of the throat. Now using robotic surgery with even more advanced technology, using the single port, we’re able to home into where these tumors are, make more exact cuts around the tumor, which allows us to take less tissue, offer patients a quicker recovery, and get them to necessary adjuvant treatments like radiation faster.

This must be a benefit for patients who live in this region, who previously would have had to travel far if they wanted this more modern approach.

Utah is a major catchment area for several surrounding states. We’re seeing patients coming from Idaho, Wyoming, Montana, Nevada, parts of northern Arizona, or Colorado. We are a major center that’s offering this for a multi-state area. Before that, if they wanted this advanced technology, they might have to seek care otherwise. While these patients still have to sometimes drive very long lengths to get here, at the end of the day, we can serve as this major catchment area that’s able to provide this advanced technology for patients who need it in our region.

Are there any next steps or future directions that you would like to see taken with the single-port robot?

We continue to advance the way we’re able to use this robot for these types of procedures. Some centers are even using this for advanced surgical procedures for obstructive sleep apnea. We may continue to see the utilization of this robot continue to advance in terms of the types of procedures that we’re able to offer patients. In addition, in terms of oropharynx cancer in general, we’re becoming more precise in the way we’re treating these patients. It's the culmination of these minimally invasive surgical techniques.

Now we’re able to use circulating tumor DNA where we’re able to monitor patients with HPV-derived oropharynx cancer. We’re able to monitor their tumor response to surgery using DNA levels in their bloodstream after surgery. We’re able to detect early recurrences and determine how effective our surgery was, so it’s an exciting time to be a head and neck cancer surgeon who takes care of patients with oropharynx cancer. It’s these novel surgical techniques using the single-port robot and looking at plasma or liquid biopsies that were able to determine tumor response. We’re just going to continue to be able to provide more precision medicine for these patients in the future.

Reference

Single-port robotic surgery is making its debut in the Mountain West. Huntsman Cancer Institute at the University of Utah. January 29, 2024. Accessed February 29, 2024. https://shorturl.at/dBCZ5