Minimally Invasive Head and Neck Surgery: What’s new?

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Written By MartinCorbett

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Traditions of surgery from the past

Once upon a time, when you went in for an ear, nose or throat surgery, your surgeon would make large incisions to reach the difficult-to-reach areas of your anatomy. For large thyroid conditions, such as goiters, incisions of up to 10 cm were common.

Sometimes, surgery required a highly invasive approach, such as splitting the jaw to allow the surgeon to access the patient’s throat. This could cause further complications.

To get to the surgery area, a lot of normal tissue would need to be removed, including portions of the neck and swallowing muscles. The skin and flesh from the thighs would be used to patch up the wound. Radiation and chemotherapy are often combined in cases of cancer. This increases the chance of complications.

Now, fast forward to the new techniques of today

Endoscopy technology and robotic arms have made ENT surgery much more accessible for treating throat, thyroid, and oral cancers.

The surgical robot allows us to perform TORS (trans-oral robotic surgery). This involves inserting an endoscope and various robotic arms into the mouth to remove cancerous cells. Previously, this was done by cutting open the jaw.

Because these techniques are minimally invasive, we don’t have to remove so much normal tissue. We also don’t have to transplant any tissue from another part of the body. Instead, wounds heal naturally and contract to connect the normal structures around them. This allows for almost normal anatomy to be maintained. You don’t experience the same loss of sensory sensation in your swallowing muscles that you experienced with transplanted tissue.

Because we can access the tumour better and take it out completely, radiation and chemotherapy are less necessary. Sometimes, early stage cancers can be removed completely without the need for chemotherapy.

A faster recovery and a higher quality of life

These ENT surgical techniques offer a variety of benefits for patients:

  • Greater chance of survival
  • You can eat and drink more regularly, which will improve your quality of life.
  • Shorter treatment duration

Lower treatment costs

If the entire cancer can be treated by surgery, then chemotherapy and radiation should not be used.

Thyroid surgery is now painless

There are many situations where the thyroid or part thereof must be removed. These include when it produces too much hormone, if there is no evidence of cancer or suspicious growths, or when the thyroid has swollen enough to compress the airway as a goitre.

A hemithyroidectomy is a procedure that removes half of the thyroid. Or a total thyroidectomy, which involves the complete removal of the entire thyroid. Sometimes, if there is more severe cancer, we may need to remove lymph nodes surrounding the thyroid.

As long as nodules are not dangerous, we can offer scarless options by using an endoscope to view the mouth, inside the lip, behind the ears, and even below the ear. You no longer have to worry about a visible scar on the neck or needing special accessories or clothing.

Recovery times are faster

  • You can expect to be as minimally invasive as possible during the procedure.
  • You will be back at home in 1-5 days
  • Eat and drink by the first day
  • Within a few days, you can resume your normal daily activities.
  • Within 2 weeks, you can return to work or exercise.

Assessing the risks

Thyroid surgery is like any other type of surgery. There are many critical structures around the gland that control movement, including the recurrent nerves.

Inadvertently injuring one side can cause hoarseness and injury to the other may result in difficulty breathing. The risk of nerve injury in the hands a skilled surgeon is low. Robotic assistance can make it even less likely. The da Vinci robot, a surgical system that allows surgeons to operate through small incisions, provides a magnified view of the brain and flexible tools that can help preserve and identify the nerves.

The possibility of bleeding in the thyroid is very serious. It can cause airway compression which could be life-threatening. It is crucial to find a good aftercare center to ensure that any complications are identified early to allow for prompt medical treatment.

How to choose a surgeon

A surgeon who has sufficient experience can minimize surgical risks and can handle more complicated cases such as total thyroidectomy or removal of lymph nodes.

Ask them how many times they have done the exact same procedure that you are undergoing. Surgeons with limited or no experience may not know what is possible.

Make sure the surgeon is experienced in robotic and endoscopy surgery.