Robotic Surgery Through a Single Incision Now Offered to Some Cancer Patients

Through a single incision of approximately one inch, doctors at Baptist Health Miami Cancer Institute are now able to perform robot-assisted surgery on some patients with head and neck cancers, urologic cancers, and soon, gynecologic cancers. The single-port technology is part of Baptist Health’s robotic surgery program, one of the highest-volume programs in the country.

John Diaz, M.D., chief of gynecologic oncology at Baptist Health Miami Cancer Institute

“Minimally invasive surgery through the robotic approach has really revolutionized how we perform surgery, and with this novel technology we now have better access to more narrowed areas of the body,” said John Diaz, M.D., chief of gynecologic oncology at the Institute.

Dr. Diaz, who is also director of robotic surgery and chair of the Robotics and Innovations in Surgery Subcommittee at Baptist Health, said that as the evolution of robotics continues, the number of patients who can benefit from the technology will expand even further.

(Watch now: Through a single incision about an inch long, doctors at Miami Cancer Institute can now perform robot-assisted surgery on patients with some types of cancers – including, soon, gynecologic cancer. Video by Carlos Barquin, Jr.)

Single port for head and neck cancers

Head and neck surgical oncologist Meghan Crawley, M.D., is using the new technology for patients with oropharyngeal cancers ― cancers of the tonsils, the back of the tongue and back of the throat, and the soft palate. “The single-port system is really designed to fit into the small space of the throat and still gives me the ability to maneuver. I have better visualization. It’s really an improvement over what we had,” she said. No incision is required as the port goes through the throat.

Meghan Crawley, M.D., head and neck surgical oncologist at Baptist Health Miami Cancer Institute

Traditional open surgery for many head and neck cancers can be particularly difficult for patients. “We would have to split the jaw and then rotate it to have access. It would be an all-day surgery,” Dr. Crawley said. “Now, we can be done in a couple of hours or less, the patient is typically in the hospital overnight and the recovery is much faster.”

The most common oropharyngeal cancers that Dr. Crawley sees are related to human papillomavirus (HPV), which is a sexually transmitted virus. Most cases of HPV do not lead to cancer, but when they do, they are typically slow growing with symptoms appearing many years after infection.

Patients with HPV cancers tend to be older at the time of diagnosis, so less-invasive procedures such as the single-port technology are often a better option compared with traditional, open surgery, Dr. Crawley said. In addition, successful surgery may allow some patients to avoid chemotherapy and radiation therapy, which can be very effective but also carry toxicity risks.

Single port for urologic cancers

While the single-port system isn’t ideal for the most complex urologic cancer surgeries, Murugesan Manoharan, M.D., chief of urologic oncologic surgery and director of robotic urologic surgery at Miami Cancer Institute, will be using it for select patients. The best candidates are patients with straightforward kidney tumors and small prostate cancers, as well as some men with benign enlargement of the prostate and some women with urinary incontinence or pelvic organ prolapse.

Murugesan Manoharan, M.D., chief of urologic oncologic surgery and director of robotic urologic surgery at Baptist Health Miami Cancer Institute

 “It’s an evolving technology and there will be more we can do in the future,” he said. “It’s similar to the advances in smart-phones that have enabled us to add features and widgets. I’m able to use augmented reality, for example, and superimpose the preoperative CT scans with intraoperative scans and know, without even touching the kidney, that behind the tumor is a blood vessel. But right now we don’t have a touch sensation with the robot. We are sitting at a console operating the tools, but a touch sensation would improve the technology even more.”

Found in operating rooms around the world today, surgical robots got their beginnings through research efforts by the U.S. military and the National Aeronautics and Space Administration (NASA) in an effort to quickly provide battlefield trauma surgery and emergency telesurgery in space. “The work done in the 1970s led to robot-assisted procedures in surgery in the 1990s and in the early 2000s the platforms we are familiar with today were developed,” Dr. Diaz said.

Most robotic systems require the surgeon to make four to five small incisions to insert each arm of the robot, and that technology is still most appropriate for most surgeries, particularly complex cases or those that require more room to maneuver within the body, Dr. Diaz said.

Benefits of robotic procedures

During a robot-assisted procedure, surgeons sit at a console and use computer and software technology to move surgical instruments through one or more incisions. In general, the benefits to robotic surgery include:

·       Less blood loss

·       Less pain

·       A reduced chance of infection

·       A shorter hospital stay and a faster return to normal activities

·       Minimal scarring

In the case of cancer patients who need additional therapies, another advantage of robotic surgery is that there is no need to wait weeks for the patient to heal from traditional open surgery before starting other therapy.  “Starting these therapies earlier has shown improved patient outcomes,” Dr. Diaz said. “Robotics has been a game changer for cancer patients and also for more routine procedures, such as hysterectomies.”

Baptist Health robotic milestones

The single-port system is pending FDA approval for gynecologic cancers. Throughout Baptist Health, surgeons are using robotic technology for everything from bariatric to thoracic to orthopedic procedures. Baptist Health has performed more than 64,000 robotic procedures. In addition, the robotics program at South Miami Hospital has performed more than 27,000 cases, placing it in the top 20 programs in the country.

The Center for Robotic Surgery at Baptist Health is designated as a Center of Excellence for Robotic Surgery by the Clinical Robotic Surgery Association and a Center for Excellence in Minimally Invasive Gynecology by the American Association of Gynecologic Laparoscopists.