Robot assisted surgery: how new technology creates opportunities in head and neck surgery

Written by: Professor Neil Tolley
Published:
Edited by: Jay Staniland

 

What is Robotic Head and Neck Surgery?

Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques.

Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field.

 

 

Why is robotic surgery used?

 

The da Vinci robot permits surgery on the tongue base and tonsils for cancer and obstructive sleep apnoea. The robot can be used to remove the thyroid or parathyroid gland in patients in selected patients wishing to avoid a scar in the neck. It is not suitable for all thyroid or parathyroid surgery.
 

  • Surgery to the tongue base (cancer and sleep apnoea)
  • Surgery to the tonsils (cancer)
  • Removal of the thyroid (avoiding a neck scar)
  • Selective parathyroid surgery where patients have a tendency to heal poorly and wish to avoid a neck scar

What are the benefits to using this procedure?

 

  • Avoidance of a neck scar in thyroid and parathyroid surgery.
  • Sleep apnoea where obstruction is at the base of tongue.
    Suitable for patients where CPAP has failed or been refused and the patients BMI is not over 30. It is not possible to perform precision surgery of the tongue base by other surgical techniques either because they are too invasive or line of sight issues which occur with laser treatment.
  • No flaps (tissue grafts) are required for cancer surgery where inpatient stay is reduced from 3 weeks to 7 days.
  • Permits less chemotherapy and radiotherapy when treating cancer. This leads to superior swallowing outcomes for the patient.
  • Robotic head and neck surgery for tonsil and tongue base cancer reduces inpatient stay from 3 weeks to 7 days. This is better for patients and reduces the demand on healthcare resources.

What complications can occur with this procedure?

 

As with any surgical procedures there are risks such as bleeding and infection. However, the postoperative recovery is significantly helped by using robotic techniques.

By Professor Neil Tolley
Otolaryngology / ENT

Professor Neil Tolley is an internationally respected consultant ENT (head and neck) surgeon based in London. He has earned worldwide acclaim for his pioneering work with head & neck robotic surgery in the UK and was the first surgeon in the UK to use the Da Vinci Robot for head & neck cancer, obstructive sleep apnoea and thyroidectomy. Additionally, he was the first surgeon in the world to perform robotic parathyroid surgery. Professor Neil Tolley treats a wide range of ENT conditions and has a special interest in surgery of the thyroid and parathyroid glands.

Professor Tolley completed his initial medical training in Cardiff in 1982 and his MD in nasal physiology in 1988. He then went on to complete specialist training at the Royal National Throat, Nose & Ear Hospital and Great Ormond Street Hospital amongst others. Professor Tolley has undertaken a number of international fellowships in San Diego, California, Cape Town and Perth and Sydney, Australia. The Royal College of Surgeons of Edinburgh appointed him a fellow in 1988 and the following year he was also appointed a fellow of the Royal College of Surgeons of England. He was accredited as an ENT surgeon in 1992. In 1994, he joined St Mary’s and Ealing Hospitals as a consultant ENT surgeon and has since been appointed lead clinician of ENT, head and neck surgery, audiology and oral surgery.

In 2010, Professor Tolley made pioneering use of telerobotic equipment to perform surgery to remove an overactive parathyroid gland and its use in selected patients to avoid scarring and lenghty hospital stays is now widely practised. His work in the field has earned him international renown and as such he is regularly invited to contribute to training programmes and conferences. Professor Tolley has twice presented his work at the World Congress of Robotic Surgery held in Orlando in 2010 and in Miami in 2011. He also visited Hamburg to assist in the first robotic thyroidectomy in Germany in 2012. Additionally, he developed the first integrated simulation training programme for ENT healthcare providers in England, which has gone on to be shared and used in the US, Sweden, Australia and Egypt.

Professor Tolley imparts his knowledge in a number of educational roles for medical trainees. He is a programme and simulation course director for ENT training in North Thames and has supervised a number of MSc, MD and PhD students in his role as Professor at Imperial College, London. Additionally, Professor Tolley is a surgical tutor at St Mary’s Hospital. In addition, he is course organiser for the Imperial MSc in Surgical Innovation - ENT and runs a twice yearly DOHNS course. Professor Tolley has published in excess of 200 peer-reviewed publications. He is a regional adviser to the Royal College of Surgeons (England) for North Thames West. He is also secretary and president elect to YCOHNS (Young Consultants Otolaryngology-Head and Neck surgery). Professor Tolley is also chairman of the London Consultants’ Association and an executive board member of the British Association of Endocrine and Thyroid Surgeons.

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