24 Dec 2011
By: POON CHIAN HUI
A NEW robotic procedure could spare some patients with tongue, throat or tonsil cancer from a disfiguring surgery that involves splitting the jaw into two.
They would also have little to fear about being unable to chew or swallow normally after the tumour is removed.
Termed the TransOral Robotic Surgery (Tors), this technique allows doctors to get to hard-to-reach tumours through the mouth.
Singapore General Hospital (SGH) is the first centre in South-east Asia to use this method to treat cancers of the throat, tongue and tonsils as well as sleep apnoea, a disorder where one stops breathing for brief periods during sleep.
So far, five patients have successfully undergone the operation, which makes use of a da Vinci Surgical System made by American company Intuitive Surgical.
The system is currently used here for other procedures, mainly prostate cancer surgery. SGH was also the first in Singapore to buy the robot in 2003.
Doctors handle a computer console controlling two instruments attached to robotic arms. Along with a camera, these instruments can be navigated through the mouth to access the tumour, which can be cut out without making any incisions.
This latest minimally invasive procedure takes less than two hours. Recovery is faster, with patients able to eat after a few days. They can be discharged from hospital a week later.
In contrast, conventional open surgery involves cutting the neck from ear to ear, and splitting the jaw into two, so that it can be "swung" outwards to reveal the throat cavity. This operation takes eight to 12 hours.
Most patients will need to undergo chemotherapy and radiotherapy, and up to 38 per cent will need permanent help with eating afterwards via a feeding tube.
Patients may take up to two weeks before they can start eating again, and have to stay in hospital for at least two weeks.
"It's a massive surgery – the jaw is not going to be quite the same after that," said Dr Tay Hin Ngan, an ear, nose and throat specialist.
But the SGH consultant doctor noted not all patients are suitable for the new surgery. Generally, those whose tumours have not invaded too deeply into tongue muscles or the jawbone would be suitable.
But Dr Tay, who is one of the five doctors here trained in the new technique pioneered in the United States, added that Tors patients with advanced stage cancers need not undergo chemotherapy, which is usually required after open surgery.
"Being able to avoid chemotherapy is useful because it's very toxic and comes with a lot of side effects," he said. They include vomiting and hair loss.
Patients pay about $2,000 to $6,000 more for the robotic surgery compared with conventional surgery. But other medical expenses such as hospitalisation fees would be lower due to quicker recovery.
This development is in line with a trend towards less invasive surgery using robots which offer more precision and better access to areas such as the intestines.
At least four other hospitals here have also latched on to the robotics option.
Singapore has about 40 new cases of tongue cancer every year. Another 40 are linked to oropharynx and hypopharynx cancers. The former can be described generally as the area of the throat that sits at the back of the mouth. The latter is the part of the throat that connects to the oesophagus, a tube where food is channelled to the stomach.
SGH, together with the National Cancer Centre Singapore, had about 50 oropharynx and hypopharynx patients last year. The survival rate for early stage cancers of the throat, tongue and tonsils is about 80 per cent.
Email: chpoon@sph.com.sg
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