Source: San Diego Business Journal

By: Steve Sinovic

The first transoral robotic surgeries in San Diego have been performed at Sharp Chula Vista Medical Center and all three patients who underwent those procedures are recovering well, said the surgeon who is leading up the effort to help patients beat early-stage oral cancer.

Advances in robotic surgery prompted the hospital to look for ways to apply that technology to treat tumors of the mouth and throat. And thanks to a local benefactor, the institution hopes to be performing more procedures on local patients.

The hospital is one of fewer than a dozen in the U.S. to offer the procedure, which was launched thanks to a $1.2 million anonymous donation to Sharp Chula Vista. The donation helped fund the acquisition of Intuitive Surgical Inc.’s da Vinci Surgical System, said Dan Dredla, vice president of business development for the 343-bed hospital in south San Diego County.

“We were fortunate that a donor helped us purchase the da Vinci,” said Dredla. “It’s a costly system, and it was challenging to find the capital to acquire it on our own.”

The da Vinci robot, which combines enhanced 3-D views with precise incision capabilities, is already being used for various surgeries at hundreds of hospitals throughout the country and around the world. However, it was just recently that the U.S. Food and Drug Administration approved using the da Vinci for the transoral surgeries, or TORS, procedures on head and neck cancers.

While Dredla didn’t have exact figures on how many patients the hospital admits with head and neck cancers, it’s probably 3 percent to 5 percent of all patients with cancer. Not all of these patients will have surgery. Sharp Chula Vista admits about 400 inpatients per year with a primary diagnosis of cancer. That’s just inpatient admissions — hospital staff also treats many more on an outpatient basis.

Technological Forefront

Dr. Albert McClain, an ear, nose and throat specialist affiliated with Sharp Chula Vista, said acquisition of the TORS system is significant.

“This is going to allow us to be at the very forefront of technology when it comes to giving our patients the very best possible outcomes,” he said.

Based on McClain’s estimate of the number of procedures he expects to perform, the institution may see a modest increase in the number of surgeries for oral cancer at Sharp Chula Vista.

Oral cancer is the only head and neck cancer for which the FDA approves the use of the robotic surgical system. Other types of head and neck cancers affect the salivary glands, sinuses, pharynx, larynx, and lymph nodes in the upper neck.

The most common robotic surgical procedures at Sharp Chula Vista are for urological and gynecological conditions, especially prostate cancer, uterine fibroids and endometriosis.

In terms of revenue stream, insurance companies do pay hospitals for treating patients with the robotic system.

“We’re not generating more revenue with each case that uses a robotic system,” said Dredla. “In fact, the cost of the robotic system actually erodes our profit margin.

“Where we (hospitals) benefit financially is by using a surgical technique that reduces overall length of stay and complications. That helps with downstream revenue and expense.”

Innovative Automation

Named after the famous Italian artist Leonardo da Vinci for his intricate engineering designs, the da Vinci Surgical System was approved by the FDA in 2000 and was the first robotic equipment allowed in U.S. operating rooms. Other San Diego hospitals use the da Vinci as well.

TORS, a minimally invasive endoscopic technique, targets removal of early-stage tumors of the tongue base, throat, larynx and skull base. Traditionally, those cancers have been removed through either an incision in the neck or through the mouth, which often requires splitting the lower lip and dividing the jaw.

According to the American Cancer Society Inc., nearly 40,000 new diagnoses of oral cancer are made every year, but they’re usually not discovered until they have advanced significantly.

“Oral cancer can be hard to catch because the symptoms vary,” said McClain. “Some patients experience ear pain or have difficulty swallowing, while others have no symptoms at all.”

Treatment for oral cancer typically includes a combination of radiation therapy, chemotherapy and surgery, but traditional surgery involves large incisions which can have devastating side effects like facial disfigurement and permanently impaired speech, eating and swallowing.

Pioneers in Surgical Procedure

McClain received his TORS training at the University of Pennsylvania from the physicians who founded the new procedure and set up the world’s first TORS program in 2004.

The three initial cases he has treated were not very difficult cases, but gave McClain and his team an opportunity to work with the technology. The cases were a benign palate tumor and early-stage tonsil cancers.

“TORS isn’t for everyone, but it’s an important option to have,” McClain said. “It’s amazing how treatment for oral cancer is advancing.”