UI Otolaryngology - at forefront of use of a new, versatile robotic system

UI Otolaryngology recently obtained a Flex® Robotic System, new robotic solution that fills the need for treating conditions and areas of the body that previously were extremely difficult or impossible to access, said Barry L. Wenig, MD, MPH, Francis L Lederer Professor, interim Department head, and director of head and neck surgery and robotic surgery.

“This system was developed to fill a need, specifically single orifice surgery,” Dr. Wenig said. In October, he performed his first operation with the system – a laryngopharyngectomy. “The system allowed me to identify where the internal cuts needed to be in order to obtain negative margins of resection as well as to allow Dr. Marco Ellis, the reconstructive surgeon, to plan the dimensions of the flap that he was going to use to perform the reconstruction.”F

The system uses a flexible scope that allows the surgeon to maneuver it in a way that cannot be done by straight scopes – it can move in a non-linear way to help a surgeon get to areas other devices don’t allow so that minimally invasive treatment can be applied, Dr. Wenig said.

“Previously, our robot exposure was limited and surgical options were restricted to three or four procedures,” he noted.

“This has really opened up the field for us. It does not require a fixed location; being portable, it is easily moved from room to room . It’s not designed to replace the existing DaVinci robot but give us more procedures we can perform and therefore better serve patients.”

“The unique nature of the technology will offer us a much wider range of surgical options that will hopefully attract a larger referral audience,” he said.

To most patients, a tumor, or by its more euphemistic name, a “growth,” is a frightening prospect. Even a “benign” tumor sounds anything but benign or harmless.

Katie Chiles knows. The Chicago resident saw her doctor for what she thought was a routine case of the flu. But during that exam, her doctor noticed a growth in her throat that tests quickly confirmed to be a fast-growing non-cancerous tumor that began in her nose and had expanded to cover her esophagus and much of her throat. Having noticed nothing except swelling in her gums before that diagnosis, Chiles was understandably shaken. “I was really frightened,” Chiles said. “It could turn out to be cancerous, and even if not, it could close my throat.” While her doctor said the tumor could be removed through traditional open surgery, he knew the risks of surgery on a growth of that size in that part of the throat. He told Chiles that robotic surgery could be a much safer, less-invasive option, and suggested she see Barry Wenig, M.D., MPH, Ph.D., FACS.

Dr. Wenig, a University of Illinois Hospital & Health Sciences System Professor, Diplomate of the American Board of Otolaryngology, and Director of the Head and Neck Cancer Program, is a pioneer in the use of robotic surgery in a range of ENT cases. Robotics has in recent years expanded into head-and neck surgery applications, and Dr. Wenig is recognized as a national and international leader in the field. When Chiles met Dr. Wenig, he told her that even a benign tumor of the size of the one she had in her throat involved potentially significant risks under open surgery. He told Chiles that, over the long term, even though the growth was not cancerous, its rapid growth was potentially dangerous, and that the tumor could become cancerous. Moreover, he said, robot-assisted surgery would be the best option for Chiles. “Robotic technology allows us to see the affected area in 3-D, in a super-magnified way,” said Dr. Wenig, who performs Transoral Robotics Surgery on patients with cancerous and non-cancerous throat tumors.

“Katie’s tumor, while not malignant, posed real dangers,” he said. “It could easily have grown to completely block her throat and threaten her ability to swallow at all.” “It had the potential to be a serious, even life-threatening issue,” he added. “Open surgery in the throat region usually requires the surgeon to cut through the jaw,” Dr. Wenig said. “Sometimes, depending on the location of the tumor, breaking the jaw might be required to get to and remove the whole tumor. That can lead to irreversible effects to a patient’s ability to swallow, chew, and speak, not to mention other quality-of-life issues.” “With robotics, our ability to see the whole area affected by the tumor lets us pinpoint our treatment,” he said. In head and neck cases, this is particularly important, given the small surgical field in play, he added. “That made Katie’s unique case a perfect fit for robotics surgery.”

Chiles, who didn’t know much about robotics before her diagnosis, was “paranoid that the tumor would grow so big,” she remembered. “But Dr. Wenig told me right away he could get to it. His bedside manner and confidence in getting it out made me instantly comfortable,” she said. “I knew there were still risks, but I felt safe with him,” she added. She’d experienced multiple effects of the tumor, which had wrapped around a tonsil and was affecting her sinuses as well. Her sleep was affected, and her voice had grown so deep that people took her for a man on the telephone. “It was a deep, deep voice, getting deeper. It was becoming hard to form words,” Chiles noted. But the process of getting to Dr. Wenig, then through surgery, was fast, just a few weeks in all, so her worries were minimized. And what Dr. Wenig told her to expect after surgery – from about six weeks of a liquid-only diet, to a change for the better to her voice – was exactly what she experienced. “My voice is a little higher and softer now,” she noted.

While the lack of solid food, combined with the surgery and its attendant soreness in her throat, left her weak and losing weight, her daughter’s prescribed diet of several protein shakes a day helped restore some energy. Katie is breathing more easily and sleeping better now and the apnea condition seems to be relieved now that her airway is clear. She isn’t as reliant on her CPAP machine to sleep. She also returned to work for the Chicago Transit Authority within three months of her operation, something that would not have been the case had she undergone open surgery. “Katie’s realizing the benefits of less-invasive surgery when performed under the right conditions,” Dr. Wenig noted. “What she’s experiencing is what robotics is about: complete removal of the growth, and an expeditious improvement of quality-of-life issues with faster recovery and relatively minimal postoperative effects.” Dr. Wenig has seen Chiles several times since the surgery, weekly at first immediately after surgery, and the prognosis is outstanding. The growth, he said, is completely eradicated. And for Chiles, getting back to her normal life is testament to Dr. Wenig’s expertise and the immediate confidence she felt at their first meeting. “I had faith in him from the beginning,” she said.