Source: www.todayonline.com
Author: staff

Singapore — When Mdm Tan Chwee Huay told her friends that she had undergone surgery to remove a cancerous lump in her throat, they thought that she was pulling their leg.

“Nobody could tell that I had gone for such a complex surgery because they could not see any scars.

“They only learnt about my cancer diagnosis after the surgery, and they were shocked,” said the 75-year-old housewife, who was diagnosed with advanced-stage throat cancer in late 2010.

Shortly after her diagnosis, Mdm Tan underwent a surgical procedure known as transoral robotic surgery (TORS) to remove a 2cm lump from the base of her tongue.

Traditionally, conventional surgery for head and neck cancer involving the base of the tongue and throat required making large incisions in the neck, or sawing through the jaw to remove the growth, said Adjunct Assistant Professor Tay Hin Ngan, director of HN Tay ENT, Head and Neck, Thyroid, Sleep and Robotic Surgery at Mount Elizabeth Novena Hospital.

Incisions from a typical open-neck surgery can extend beyond 20cm, said ENT/head and neck surgeon Dr Jeeve Kanagalingam, a visiting consultant at Johns Hopkins Singapore.

While a skilled surgeon can conceal the incisions within creases or folds of the skin, Dr Kanagalingam said, patients who are predisposed to keloids could risk developing thick, raised scars.

However, advancements in robot-assisted surgical systems have made it possible for surgeons to perform such surgeries without making a visible incision in the neck or face.

Prof Tay, who performed TORS on Mdm Tan, said the “scar-less” surgery is performed through the mouth using the da Vinci surgical robot via a remote control console.

“The robot allows us to work around corners and operate in areas where the human hand previously could not have reached without cutting through the neck or sawing through the jaw,” he explained.

From Pelvic Surgery to Treating Cancer
Prof Tay said Mdm Tan is one of the first few people in Singapore to have undergone TORS since it was introduced here in 2011.

The da Vinci system was previously used in pelvic surgeries, where access for surgery is limited, said Dr Kanagalingam.

In recent years, the robotic surgical system has extended to head and neck operations. TORS can also be used to treat snoring and obstructive sleep apnoea (OSA) by reducing the bulky tongue base tissue blocking the airways.

To date, Prof Tay has performed about 20 TORS procedures for cancer and obstructive sleep apnoea.

“In general, surgery is often the best choice for thyroid and tongue cancers, and advanced laryngeal (voice box) cancers. For cancers in advanced stages, most patients undergo a combination of treatments,” said Dr Kanagalingam.

With the availability of robotic surgery, chemotherapy and radiotherapy need not be the first-line treatment, added Prof Tay.

“Robotic surgery can remove a tumour first, reducing the amount and area of radiation needed, and allow for less aggressive chemotherapy,” he said.

Fewer Complications
Compared with conventional head and neck surgery, patients who undergo TORS have a lower risk of certain post-surgery complications.

“One of the dreaded complications of open surgery is the risk of saliva leaking through a neck wound. As no neck incision is made during TORS, the risk of this complication is minimal,” said Prof Tay.

Another boon, added Prof Tay, is that patients are able to preserve their swallowing function, as the TORS procedure does not cut through swallowing muscles to reach the tumour. A day after her surgery, Mdm Tan was able to consume a soft diet without much pain during swallowing. With conventional open surgery, patients such as Mdm Tan might require tube feeding for 10 to 14 days before being allowed to try liquids and slowly progressing to solids.

She may not be able to eat solid food for a month, said Prof Tay.

However, not all head and neck tumours can be removed using TORS and every patient needs to be assessed carefully, said Dr Kanagalingam.

As with any surgical procedure, there are also some risks involved in TORS, including bleeding in the tongue and throat.

“This is potentially life-threatening if not handled well, so an experienced robotic surgeon is essential.

“This risk is higher in tumour surgery compared to OSA surgery, as we go deeper and are more likely to encounter these vessels.

“Other risks include damage to the teeth, tongue swelling and change in the sense of taste. But these usually recover on their own with time,” said Prof Tay.