An increasing number of cancer surgeries can now be performed with minimally invasive techniques that provide effective treatment with a much smaller impact on the patient.
Minimally invasive surgery, also known as keyhole surgery or laparoscopic surgery, uses tiny surgical tools that can access tumors through incisions less than an inch in length.
A laparoscope is a long, thin tube with a microscopic lens that allows the surgeon to view the entire abdominal cavity on a large computer screen. The laparoscope is inserted through a tiny incision near the navel. Other incisions are made for specialized surgical instruments to perform the operation without having to make a large external incision.
Minimally invasive surgery has several advantages over conventional “open” surgery:
- Less blood loss
- Decreased need for blood transfusions
- Shorter hospital stays
- Decreased pain and need for pain medication
- Quicker recovery and return to normal activities
- Less scarring and improved cosmetic appearance
Robotic surgery systems consist of one or more robotic arms remotely controlled by surgeons. One robot arm has a laparoscope. Other arms hold tiny surgical instruments that can fit into an incision less than an inch long. The surgeon sits at a console with 3-dimensional views of the tumor. A joystick similar to that for a video game precisely controls each robotic arm.
Although the robot arms are doing the actual surgery, they still require direct input from the surgeon and cannot be operated without human intervention. Robotic surgery has the benefit of reducing surgeon fatigue and eliminating hand tremor during long, complicated procedures.
MD Anderson uses robotic surgery for removing the prostate or kidneys. It can also be used for removing tumors in the uterus, lung and colon.
Transoral Laser Microsurgery
Transoral laser microsurgery (TLM) is used to treat small tumors in the throat and larynx. A carbon dioxide (CO2) laser beam is used to cut through tissue with more precision than a scalpel.
For the transoral laser microsurgery procedure, an endoscope is inserted through the mouth to view the surgery site. A specially designed microscope is aligned with the endoscope, which helps surgeons guide the laser beam. The beam may be continuous or fired in short bursts, or pulses.
The CO2 laser beam generates minimal heat, limiting damage to structures that are crucial for speech and swallowing functions. It also seals off blood vessels and cauterizes the edges of the wound, resulting in much faster healing.
After Tony Loth was diagnosed with tonsil cancer, a local specialist told him the best course of action was a radical neck dissection. He accepted this plan and went home. His doctor was the expert, after all.
Later that night, his wife, a dentist, drew out the procedure for him. Now he could see just how invasive it would be. “If that’s what it takes to beat cancer, I’ll do it,” Tony thought. But he wondered if there was an easier way.
That’s what led him to MD Anderson. Here, doctors outlined a much simpler surgery -- one that would be performed robotically. The difference that decision made in his recovery and side effects has changed Tony’s life.
Tony’s tonsil cancer diagnosis
In October 2018, Tony woke up one morning and noticed a lump on the left side of his neck. It seemed to have popped up overnight. His wife urged him to see a doctor.
The doctor suggested that it was an inflamed lymph node and prescribed a round of antibiotics. When that didn’t clear it up, he saw an ear, nose and throat specialist, who performed a biopsy. It came back negative, but the doctor was still suspicious. He suspected that Tony had tonsil cancer. A second test confirmed this diagnosis. After the doctor suggested the radical neck dissection, Tony’s wife persuaded him to call MD Anderson. Since he lived in Fort Worth, just a few hours north of Houston, he knew of MD Anderson’s expertise. But he thought he was unlikely to be able to get an appointment.
“That was probably the biggest misconception I had before going to MD Anderson,” Tony says. “I thought you had to have a connection to get an appointment. But my wife just called the main number. I had an appointment a few days later. The people at MD Anderson – all of them -- are so helpful.”
Coming to MD Anderson for tonsil cancer treatment
Tony’s first appointment was with Jeffrey Myers, M.D., a head and neck cancer surgeon.
“He immediately put me at ease,” Tony says.
Myers looked at Tony and told him, “This is very curable. It’s something we see a lot of.”
After undergoing more scans and biopsies to confirm his diagnosis, Tony’s care team determined that head and neck cancer surgeon Neil Gross, M.D., would perform surgery to remove the cancer and one of Tony’s tonsils. Afterward, Dr. Gross would determine if he needed additional treatment, including chemotherapy and radiation therapy. During the surgery, Gross would use a robot that could more nimbly remove the area affected by the cancer, preventing Tony from having to deal with a long and painful recovery.
Tony asked if he should just go ahead and have both his tonsils removed.
“You have two tonsils for a reason,” Gross explained to Tony. “We don’t want to take anything out we don’t have to.”
Robotic surgery means easy recovery
On Feb. 14, 2019, Tony had his tonsil removed. He recovered in the hospital for two days, and after one night in a nearby hotel, he and his wife drove home to Fort Worth. Tony suffered some pain initially, but it soon subsided. He couldn’t believe how easy his recovery was. Prior to surgery, a specialist at MD Anderson taught him how to swallow so he could start eating soon afterward.
“It was enormously helpful,” Tony says. He jokes that he gained weight following surgery a little more quickly than he would have liked.
A few days later he received a call from Justin Sellers, a physician assistant who worked with Gross. The surgery had been a big success, Sellers told Tony. There was no need for chemotherapy or radiation treatment.
“It meant so much that Justin called me right away,” Tony says. “He knew how important that phone call was to me.”
Gratitude for caring
Tony has now been cancer-free for almost two years. Throughout his experience at MD Anderson, he had been struck by how personable everyone he met was.
“Everyone who works at MD Anderson wants to make you feel comfortable. If a staff member sees you are lost walking through the halls, they will stop and help you,” he says, recalling a time when staff directed him to the correct elevator.
He had expected his doctors to be extremely knowledgeable, but he hadn’t expected them to be so caring, too.
“They’re the epitome of specialized. All they do is cancer all day,” Tony says. “But mostly, they’re just real people who really care about you and really care about what they’re doing. I would recommend that anyone who is diagnosed with any form of cancer, no matter how bad it looks, call MD Anderson. Caring is what they’re all about.”
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