Patients at Manatee Memorial Hospital can get all the advantages of minimally invasive, advanced robotic surgery because our experienced physicians at the Surgery Center use the da Vinci® Surgical System. This minimally invasive technique helps reduce pain and trauma to the body, lessens blood loss, lowers risk of infection, shortens length of hospital stay and promotes quicker recovery with less scarring.
In this segment, Axay Kalathia, MD., discusses da Vinci® Robotics for head and neck cancer and how many hospitals offer cancer treatment, but not many balance powerful treatment strategy with the right dose of sensitivity for their patients like Manatee Memorial Hospital.
Selected Podcast
da Vinci® Robotics for Head and Neck Cancers
Featured Speaker:
He has been a board certified practicing Otolaryngologist at ENT Associates of Manatee since 1997. Over the years he has been involved with the American Academy of Otolaryngology - Head and Neck Surgery, American Academy of Otolaryngic Allergy, American Academy of Facial and Plastic Reconstructive Surgery, the Manatee Medical Society and the the Florida Society of Otolaryngology. He is actively involved in the teaching of medical students and residents.
Learn more about Axay Kalathia, MD
Axay Kalathia, MD
Axay Kalathia, MD is an Otolaryngologist and a member of the medical staff at Manatee Memorial Hospital.He has been a board certified practicing Otolaryngologist at ENT Associates of Manatee since 1997. Over the years he has been involved with the American Academy of Otolaryngology - Head and Neck Surgery, American Academy of Otolaryngic Allergy, American Academy of Facial and Plastic Reconstructive Surgery, the Manatee Medical Society and the the Florida Society of Otolaryngology. He is actively involved in the teaching of medical students and residents.
Learn more about Axay Kalathia, MD
Transcription:
da Vinci® Robotics for Head and Neck Cancers
Melanie Cole (Host): The da Vinci Surgical System offers a minimally invasive alternative to both open surgery and laparoscopy. Because it requires only a few tiny incisions and offers greater vision, precision and control for the surgeon; patients can often recover sooner, move onto addition treatments if needed and get back to daily life quicker. My guest today is Dr. Axay Kalathia. He is a head and neck surgeon and a member of the medical staff at Manatee Memorial Hospital. Welcome to the show doctor. So, what cancer procedures can be performed using this robotic technology?
Dr. Axay Kalathia, MD (Guest): The robotic technology is very advantageous for head and neck cancers that involve the oropharynx. The oropharynx is the area in the back of the oral cavity or the back of the throat. Traditionally, it has been a very challenging area to visualize and treat and the robotic technology gives us access to that area to safely and more effectively remove the cancers.
Melanie: So, as they have typically been difficult to visualize, how is this different than performing these procedures using the traditional surgical methods? What do you do differently?
Dr. Kalathia: Traditionally, the surgery to access that area would be very extensive, oftentimes having to split the jaw open to get all the way into the back of the throat because for a cancer operation, you really have to have good visibility and initially the way to visualize these cancers would be to split open the jaw, get all the way into the back of the tongue, back of the throat so you can accurately remove the cancer. But as you can imagine, that would involve a lengthy recovery time, larger scars, larger blood loss, higher infection rate and because of that, surgery for the oropharynx really went out of favor for a number of years and most people required radiation and chemotherapy to try to avoid such a debilitating surgery. But the robotic surgery has allowed us to again do surgery in that area because the access is much more minimal and the recovery is much faster.
Melanie: So, let’s speak about the recovery a little and some of the benefits to the patient and even with some of these oropharyngeal cancers, Dr. Kalathia. It’s not necessarily vanity, but as you stated these are difficult cancers to treat because of their location, but also because of what it’s like for the patient afterward. So, how does this make that a little bit better?
Dr. Kalathia: Yeah, that’s a good question. And of course, when it comes to the face, we don’t want to underestimate cosmetics as well, especially when there is deformities that could potentially occur from disfiguring surgery. So of course, the obvious advantage is there is less scars, less deformity. More importantly, is the swallowing is a big issue. As you can imagine, our throat is very important to initiate and carry out a swallow and the problem with these debilitating surgeries we used to do is the swallowing would oftentimes be difficult for many patients. Even with the radiation and chemo, that replaced the older surgery; that has always been the big problem is the patients would have a very tough time swallowing and sometimes up to 20% of patients would not be able to swallow. So, the big advantage the robotic surgery affords us is it allow us to get just as high a cure rate with less of a cosmetic deformity and more importantly, a much better swallowing success rate for a larger number of patients.
Melanie: What about benefits to the surgeon? Are you in a better position, you mentioned visualization? How does it help you guys?
Dr. Kalathia: Well of course visibility for a surgeon is very important; so the optics of the camera afford us to see things better, access getting to places quickly and with causing less deformity is advantageous for this version as well and the robotics also has some built in features because you are sitting at a console, ergonomically, for long operations, the surgeon is in a more relaxed position so they are going to have less fatigue and be able to concentrate better and the robotics also has a built in tremor reduction feature. So, if there is any hesitation or tremor, the robotics will automatically correct for that.
Melanie: And what happens as far as recovery time? Does it minimize that and a little bit of what is life like?
Dr. Kalathia: Yeah, so the recovery time are often reduced quite substantially with this type of surgery compared to the older types of surgery. Patients are swallowing faster, many times within 3-4 days of the surgery or sometimes earlier. The need a temporary feeding tube sometimes but even when they do need it, it comes out much faster. The pain is present, all of these surgeries of course when you are operating in the back of the throat, there are a lot of nerve fibers there, so the pain is there but again, compared to the older surgery, it is not as painful and people are able to be switched to oral pain medicines rather than requiring IV pain medications much earlier.
Melanie: So, as we are talking about this TORS type surgery for oropharyngeal cancers, give us a little background on those, a little risk factor. Who is at risk for these types of cancers and who would even detect them?
Dr. Kalathia: Traditionally, if you had no history of smoking you virtually had no chance of getting throat cancers. But over the past ten to 15 years, there has been an epidemic of the human papilloma virus and the human papilloma virus is something that most of the population gets exposed to, but a certain percentage of people for reasons we don’t understand, they are not able to clear the virus from their system and very rarely, it can lead to a cancer. But the majority of these patients we are seeing are not necessarily smokers or drinkers, they are getting it because of a viral transmission that converts some of their cells into a cancer. So, the typical person we see is somebody in their fifties and sixties, prominent member of the community, very healthy otherwise and just happens to pick up this type of a cancer. And the most common presentation is a mass in the neck. So, if you feel a lump or a bump in the neck, in that age group, it is very suspicious that there may be something inside causing that neck mass. So, neck masses in adults should readily receive treatment, care and evaluation.
Melanie: So, if it is an HPV positive oropharyngeal cancer, do they expect adjuvant therapies? Is chemotherapy, radiation and any of these other things involved or is this TORS surgery pretty much what they get?
Dr. Kalathia: As with all cancers, the more advanced the cancer, the more you need all the tools in the toolbox; including radiation, chemo and surgery. The advantage of the TORS approach is that with certain levels of cancers that normally would have gotten radiation and chemo; we are able to customize the therapy based on what we find during the operation. Whereas before the operation, you would just guess how much cancer was present based on PET scans and CAT scans. Whereas when we use the TORS technique, we can verify exactly how much cancer is involving which tissues precisely, so in many cases, based upon that information; we can avoid radiation and chemo altogether or sometimes reduce the amount of radiation therapy they would have normally gotten and avoid the chemotherapy but some cancers that are very aggressive and very advanced will still need radiation and chemo.
Melanie: And what kind of training, you know is required for doctors to use the da Vinci Robot for any of these types of cancers?
Dr. Kalathia: Well certainly for doing head and neck cancer, one needs to have done an otolaryngology head and neck residency and then many times the techniques that are learned for open surgery also apply to robotic surgery so anybody doing robotic surgery of course needs to be able to be very well versed in doing any kind of open cancer head and neck surgery. As far as specifically for the TORS robotic surgery, extensive training is required both to become familiar with the technology and the machinery and how to put everything together and troubleshoot as well as some of the more specific ways in which the robot is controlled as well as relearning some of the anatomy because the robot allows us to approach things from the inside out rather than the outside in. So, surgeons need to relearn some of that anatomy from an inside out perspective and all of that training requires attending conferences, visiting the surgeons who devised this technology. I was very fortunate to be able to train under the two surgeons that invented the robotic surgery at the University of Pennsylvania. I visited that hospital on three separate occasions, observed the surgeons do the procedure, did some cadaveric training, did live animal training as well as computer simulated training so there is quite a bit of investment and time that is required for the surgeon to convert to robotic TORS surgery.
Melanie: So, in summary Dr. Kalathia, what would you like to tell people who have been diagnosed with cancer, head and neck cancer and are in need of surgery. What would you like to tell them about the robotic technology?
Dr. Kalathia: Well, first of all of course, I want to educate patients again that any time you have symptoms in the throat or a lump in the neck, if it lasts for a couple of weeks, that’s okay, but anything lasting for more than three or four weeks should definitely be evaluated by your initially your primary care doctor who will then send you to an ENT doctor for further verification. And then if you do get the diagnosis of a HPV positive cancer, the good news is that cancer is very readily treated. It is very amendable to the robotic surgery and the success rates are very, very high compared to the older forms of head and neck cancer.
Melanie: And why should they come to Manatee Memorial Hospital for their care?
Dr. Kalathia: Manatee Memorial has shown a lot of dedication. There are several surgeons on staff through many specialties that have been doing robotic surgery for a number of years. The staff is very dedicated, very trained. Along with myself, several staff members also attended TORS robotic conferences to get up to the date cutting edge training and the administration has been very supportive with giving us the proper equipment so we can utilize the latest technology for the benefit of our patients.
Melanie: Thank you so much Dr. Kalathia for being with us today. You are listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to manateeemorial.com. That’s manateememorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if robotic surgery is right for you. This is Melanie Cole. Thanks so much for listening.
da Vinci® Robotics for Head and Neck Cancers
Melanie Cole (Host): The da Vinci Surgical System offers a minimally invasive alternative to both open surgery and laparoscopy. Because it requires only a few tiny incisions and offers greater vision, precision and control for the surgeon; patients can often recover sooner, move onto addition treatments if needed and get back to daily life quicker. My guest today is Dr. Axay Kalathia. He is a head and neck surgeon and a member of the medical staff at Manatee Memorial Hospital. Welcome to the show doctor. So, what cancer procedures can be performed using this robotic technology?
Dr. Axay Kalathia, MD (Guest): The robotic technology is very advantageous for head and neck cancers that involve the oropharynx. The oropharynx is the area in the back of the oral cavity or the back of the throat. Traditionally, it has been a very challenging area to visualize and treat and the robotic technology gives us access to that area to safely and more effectively remove the cancers.
Melanie: So, as they have typically been difficult to visualize, how is this different than performing these procedures using the traditional surgical methods? What do you do differently?
Dr. Kalathia: Traditionally, the surgery to access that area would be very extensive, oftentimes having to split the jaw open to get all the way into the back of the throat because for a cancer operation, you really have to have good visibility and initially the way to visualize these cancers would be to split open the jaw, get all the way into the back of the tongue, back of the throat so you can accurately remove the cancer. But as you can imagine, that would involve a lengthy recovery time, larger scars, larger blood loss, higher infection rate and because of that, surgery for the oropharynx really went out of favor for a number of years and most people required radiation and chemotherapy to try to avoid such a debilitating surgery. But the robotic surgery has allowed us to again do surgery in that area because the access is much more minimal and the recovery is much faster.
Melanie: So, let’s speak about the recovery a little and some of the benefits to the patient and even with some of these oropharyngeal cancers, Dr. Kalathia. It’s not necessarily vanity, but as you stated these are difficult cancers to treat because of their location, but also because of what it’s like for the patient afterward. So, how does this make that a little bit better?
Dr. Kalathia: Yeah, that’s a good question. And of course, when it comes to the face, we don’t want to underestimate cosmetics as well, especially when there is deformities that could potentially occur from disfiguring surgery. So of course, the obvious advantage is there is less scars, less deformity. More importantly, is the swallowing is a big issue. As you can imagine, our throat is very important to initiate and carry out a swallow and the problem with these debilitating surgeries we used to do is the swallowing would oftentimes be difficult for many patients. Even with the radiation and chemo, that replaced the older surgery; that has always been the big problem is the patients would have a very tough time swallowing and sometimes up to 20% of patients would not be able to swallow. So, the big advantage the robotic surgery affords us is it allow us to get just as high a cure rate with less of a cosmetic deformity and more importantly, a much better swallowing success rate for a larger number of patients.
Melanie: What about benefits to the surgeon? Are you in a better position, you mentioned visualization? How does it help you guys?
Dr. Kalathia: Well of course visibility for a surgeon is very important; so the optics of the camera afford us to see things better, access getting to places quickly and with causing less deformity is advantageous for this version as well and the robotics also has some built in features because you are sitting at a console, ergonomically, for long operations, the surgeon is in a more relaxed position so they are going to have less fatigue and be able to concentrate better and the robotics also has a built in tremor reduction feature. So, if there is any hesitation or tremor, the robotics will automatically correct for that.
Melanie: And what happens as far as recovery time? Does it minimize that and a little bit of what is life like?
Dr. Kalathia: Yeah, so the recovery time are often reduced quite substantially with this type of surgery compared to the older types of surgery. Patients are swallowing faster, many times within 3-4 days of the surgery or sometimes earlier. The need a temporary feeding tube sometimes but even when they do need it, it comes out much faster. The pain is present, all of these surgeries of course when you are operating in the back of the throat, there are a lot of nerve fibers there, so the pain is there but again, compared to the older surgery, it is not as painful and people are able to be switched to oral pain medicines rather than requiring IV pain medications much earlier.
Melanie: So, as we are talking about this TORS type surgery for oropharyngeal cancers, give us a little background on those, a little risk factor. Who is at risk for these types of cancers and who would even detect them?
Dr. Kalathia: Traditionally, if you had no history of smoking you virtually had no chance of getting throat cancers. But over the past ten to 15 years, there has been an epidemic of the human papilloma virus and the human papilloma virus is something that most of the population gets exposed to, but a certain percentage of people for reasons we don’t understand, they are not able to clear the virus from their system and very rarely, it can lead to a cancer. But the majority of these patients we are seeing are not necessarily smokers or drinkers, they are getting it because of a viral transmission that converts some of their cells into a cancer. So, the typical person we see is somebody in their fifties and sixties, prominent member of the community, very healthy otherwise and just happens to pick up this type of a cancer. And the most common presentation is a mass in the neck. So, if you feel a lump or a bump in the neck, in that age group, it is very suspicious that there may be something inside causing that neck mass. So, neck masses in adults should readily receive treatment, care and evaluation.
Melanie: So, if it is an HPV positive oropharyngeal cancer, do they expect adjuvant therapies? Is chemotherapy, radiation and any of these other things involved or is this TORS surgery pretty much what they get?
Dr. Kalathia: As with all cancers, the more advanced the cancer, the more you need all the tools in the toolbox; including radiation, chemo and surgery. The advantage of the TORS approach is that with certain levels of cancers that normally would have gotten radiation and chemo; we are able to customize the therapy based on what we find during the operation. Whereas before the operation, you would just guess how much cancer was present based on PET scans and CAT scans. Whereas when we use the TORS technique, we can verify exactly how much cancer is involving which tissues precisely, so in many cases, based upon that information; we can avoid radiation and chemo altogether or sometimes reduce the amount of radiation therapy they would have normally gotten and avoid the chemotherapy but some cancers that are very aggressive and very advanced will still need radiation and chemo.
Melanie: And what kind of training, you know is required for doctors to use the da Vinci Robot for any of these types of cancers?
Dr. Kalathia: Well certainly for doing head and neck cancer, one needs to have done an otolaryngology head and neck residency and then many times the techniques that are learned for open surgery also apply to robotic surgery so anybody doing robotic surgery of course needs to be able to be very well versed in doing any kind of open cancer head and neck surgery. As far as specifically for the TORS robotic surgery, extensive training is required both to become familiar with the technology and the machinery and how to put everything together and troubleshoot as well as some of the more specific ways in which the robot is controlled as well as relearning some of the anatomy because the robot allows us to approach things from the inside out rather than the outside in. So, surgeons need to relearn some of that anatomy from an inside out perspective and all of that training requires attending conferences, visiting the surgeons who devised this technology. I was very fortunate to be able to train under the two surgeons that invented the robotic surgery at the University of Pennsylvania. I visited that hospital on three separate occasions, observed the surgeons do the procedure, did some cadaveric training, did live animal training as well as computer simulated training so there is quite a bit of investment and time that is required for the surgeon to convert to robotic TORS surgery.
Melanie: So, in summary Dr. Kalathia, what would you like to tell people who have been diagnosed with cancer, head and neck cancer and are in need of surgery. What would you like to tell them about the robotic technology?
Dr. Kalathia: Well, first of all of course, I want to educate patients again that any time you have symptoms in the throat or a lump in the neck, if it lasts for a couple of weeks, that’s okay, but anything lasting for more than three or four weeks should definitely be evaluated by your initially your primary care doctor who will then send you to an ENT doctor for further verification. And then if you do get the diagnosis of a HPV positive cancer, the good news is that cancer is very readily treated. It is very amendable to the robotic surgery and the success rates are very, very high compared to the older forms of head and neck cancer.
Melanie: And why should they come to Manatee Memorial Hospital for their care?
Dr. Kalathia: Manatee Memorial has shown a lot of dedication. There are several surgeons on staff through many specialties that have been doing robotic surgery for a number of years. The staff is very dedicated, very trained. Along with myself, several staff members also attended TORS robotic conferences to get up to the date cutting edge training and the administration has been very supportive with giving us the proper equipment so we can utilize the latest technology for the benefit of our patients.
Melanie: Thank you so much Dr. Kalathia for being with us today. You are listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to manateeemorial.com. That’s manateememorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if robotic surgery is right for you. This is Melanie Cole. Thanks so much for listening.