Single Port Robotic ENT Surgery Takes Throat and Mouth Tumor Treatment to ‘A New Level’

Brian Benson, MD

Single port robotic surgery is the latest frontier of minimally invasive treatment for mouth, tongue, and throat tumors. ENT surgeons at Hackensack Meridian Hackensack University Medical Center — a renowned center of excellence for robotic surgery — are pioneers in the field of single port robotic ENT surgery, making Hackensack University Medical Center one of the first dozen hospitals in the country and the first in New Jersey to offer this innovative treatment. 

The Evolution of ENT Surgery

In the 1990s, surgical procedures to treat tumors of the throat, palate, pharynx, tongue, and tonsil involved cutting the neck and separating the jaw to access the tumor. Often, these surgical procedures resulted in scarring, disfigurement, long-term complications such as difficulty swallowing, and a lengthy recovery time.

Because these early surgical options were so invasive, many patients and physicians opted for chemotherapy or radiation therapy. However, for some people, chemotherapy and radiation therapy caused side effects such as nerve damage, dry mouth, speech and swallowing difficulties, diminished taste, neck pain, and the need for a feeding tube.

The high morbidity associated with these invasive procedures was a primary driver for developing new technology to improve surgical treatment of mouth, tongue and throat tumors.

In the early 2000s, ENT surgeons began using conventional robotic surgical systems to perform natural orifice surgery to remove tumors through the mouth — allowing surgeons to avoid making large, potentially disfiguring incisions.

However, these conventional robotic surgical systems had limitations, including rigid, straight arms that limited maneuverability in the curved, narrow spaces of the mouth and throat, and a larger camera that took up extra space in the mouth.

“With the conventional robotic surgical system, I was only able to get the camera and two arms into the patient’s mouth and it was challenging to navigate in tight spaces,” said Brian Benson, M.D., an ENT surgeon at Hackensack University Medical Center who specializes in robotic surgical procedures. “Although conventional robotic surgery was an improvement from where we were in the 1990s, I was waiting for a robot that would be more maneuverable.”

About Single-Port Robotic Surgery

In 2019, the robot Dr. Benson was waiting for arrived at Hackensack University Medical Center.

The da Vinci SP® robotic surgical system provided ENT surgeons with the flexibility, visibility and maneuverability needed to perform complex transoral robotic surgical procedures. It is approved by the U.S. Food and Drug Administration for the treatment of tongue, throat, larynx and tonsil tumors, as well as the removal of tissue causing sleep apnea.

And in contrast to the multiple arms of conventional robotic surgical systems, all of the da Vinci SP surgical instruments — including graspers, cutters, Bovie, and camera — come out of a single 2.5 cm tube.

“The single port robot allows us to navigate much better than the conventional robot due to the flexible, snakelike instruments and smaller camera,” said Dr. Benson, who was the first ENT surgeon in the U.S. to become certified on the da Vinci SP. “I can move the instruments left, right, up, down, and even make a 90-degree turn.”

“The flexible distal tip is key for ENT cancer procedures,” said Chan Park, M.D., an ENT surgeon at Hackensack University Medical Center who specializes in robotic surgical procedures. “We can control the angulation of all the instruments, including the 3D camera, which allows for much better access to and visualization of nerves, arteries, vocal cords, the tumor and other structures in the surgical area.”

“With the da Vinci SP, we now have a system designed specifically for narrow-angle surgery in a deep part of the body with little space to maneuver, which improves visibility, dexterity and precision,” said Michael D. Stifelman, M.D., Chair of Urology and Director of Robotic Surgery at Hackensack University Medical Center and Professor and Founding Chair of Urology at Hackensack Meridian School of Medicine.

Innovative Technology Benefits Patients

Transoral robotic surgery (TORS) means a faster recovery and return to swallowing, less pain, and a shorter hospital stay for patients.

“Patients who have a TORS procedure may be able to avoid radiation and chemotherapy — as well as any associated side effects, such as a feeding tube,” said Dr. Park.

Single port TORS procedures provide the added advantages of improved accessibility and safety. The da Vinci SP allows surgeons to reach places in the mouth and throat that may have been inaccessible with conventional robotic surgical systems. And smaller, more flexible instruments combined with improved visibility means a lower chance of accidental damage to teeth or other nearby tissues.

“Technical innovations that make surgery easier for the surgeon result in better patient outcomes: shorter operative time, less anesthesia, less pain, and quicker recovery,” said Dr. Benson. “The da Vinci platform makes surgeons feel so comfortable that they are able to do things they couldn’t otherwise do with their own hands and fingers.”

Among the Nation’s Most Experienced

Due to their track record of robotic surgery excellence and early adoption of single port technology, Hackensack University Medical Center’s ENT surgeons are among the most experienced in the nation at performing single port ENT procedures.

“At Hackensack University Medical Center, we are true leaders in volume, experience, innovation and technology,” said Dr. Stifelman. “We’ve taken transformational technology and put it in the hands of experienced, capable surgeons.”

“The single port system takes ENT surgery to a new level,” said Dr. Benson.