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A new robotic surgical procedure is sparing oral cancer patients like Paul Witt from a major, potentially disfiguring operation and promises to save their speech and ability to eat while possibly helping them avoid radiation.

Witt, 65, of Southgate, a retired Detroit Edison customer services representative, was among the first in Michigan to undergo TransOral Robotic Surgery.

Detroit's Henry Ford Hospital, where Witt underwent surgery Nov. 16, and the University of Michigan in Ann Arbor are among the first in the country with the technology.

Treatment for these cancers, also called head-and-neck tumors, typically requires a doctor to make large incisions in the lip, jaw and throat, causing complications that interfere with chewing, swallowing and talking. Conventional surgery and radiation also may cause significant blood loss, swelling, longer recovery and possible damage to surrounding structures.

These tumors are in the news with celebrities like movie star Michael Douglas and movie critic Roger Ebert undergoing treatment. And for reasons not clearly understood, these cancers are rising among nonsmokers like Witt. They are linked to a virus typically associated with cervical cancers.

TransOral Robotic Surgery gives cancer patients hope for recovery

With the long slender arms of a robot, Dr. Tamer Ghanem maneuvers tools that help him see and remove a large tumor from the back of Paul Witt's mouth.

It's part of new technology that promises to transform often disfiguring surgery for head-and-neck cancers.

Witt, 65, of Southgate, whose wife is in treatment for breast cancer, was among the first in Michigan to undergo TransOral Robotic Surgery.

Witt underwent surgery Nov. 16 at Detroit's Henry Ford Hospital, where some of Michigan's first dozen procedures have been done.

The University of Michigan in Ann Arbor also offers the operation and is studying whether outcomes from the surgery are equal to conventional chemotherapy and radiation.

If found to be as good as or better than traditional approaches, "the equation may shift again" to treating these cancers with a less invasive method, said Dr. Vasu Divi, a U-M clinical lecturer who performs the surgery.

For now, the approach is offered to patients with earlier stage tumors at the back of the tongue, the top of the voice box and tonsils, said Divi and Ghanem, a Henry Ford Hospital head-and-neck cancer surgeon who was among the first in the nation to offer the new technique.

The robot's three or four slender arms allow surgeons to get at structures in the mouth not easily seen or removed in traditional surgery.

The approach "allows me to see the tumor in three-dimension so I can see exactly what I'm doing," Ghanem said.

There usually is less blood loss, no visible scarring and may result in fewer complications, including pain and swelling, he said.

"The farther back it is, the harder it is to get at it," Ghanem said.

Making it even more difficult, Witt has a "large tongue and a small mouth," Ghanem said. He is testing Witt for the human papillomavirus, a germ many people carry without symptoms but that may trigger the formation of cancer. People with those tumors often have never smoked, used drugs or chewing tobacco.

"I never smoked, never drank, never did drugs and never used chewing tobacco," Witt said from a bed at Ford minutes before his surgery.

Witt's tumor was buried under his tongue and touched on his right tonsil, which Ghanem removed along with a tumor about three-quarters of an inch around.

Witt was a good candidate for the new approach because the tumor was hard to see and touch, Ghanem said. But with a tiny camera inserted into Witt's mouth at the end of a surgical tool, then displayed on TV screens in the operating room, Ghanem found the tumor and worked for three hours to remove it.

To be sure he left no trace of cancer, Ghanem sent tissue samples for biopsy several times during the surgery. After finding the borders of samples cancer free, Ghanem said Witt would likely avoid subsequent radiation or chemotherapy, which head-and-neck cancer patients typically have.

Source: Detroit Free Press