Taking the Lead in Transoral Robotic Surgery

By Trevor Willingham
Friday, November 18, 2016

With a commitment to continually upgrading its capabilities to provide optimal patient care, Penn State Health Milton S. Hershey Medical Center has become a pioneer in the use of robotic technology for surgical procedures of the head and neck.

In early 2016, the Division of Otolaryngology–Head and Neck Surgery at Penn State Health became only the second U.S. facility to acquire a revolutionary technology for head and neck procedures: the Flex Robotic System.

The endoscopic system allows surgeons to access and visualize anatomical locations that were previously difficult or impossible to reach through minimally invasive surgery.

The surgeon pilots the initially flexible camera arm, which can navigate a nearly 180-degree path to gain access to hard-to-reach areas. Once the surgeon “parks” the arm, it becomes rigid, allowing flexible instruments to pass through to the surgical target. That is in contrast to linear systems that are also used as an alternative to open surgery, but were originally designed to operate on the abdomen, limiting their utility for otolaryngology procedures.

“There are twists and turns in the aerodigestive tract,” says David Goldenberg, MD, FACS, Steven and Sharon Baron Professor of Surgery, chief of the division of otolaryngology–head and neck surgery at Milton S. Hershey Medical Center and associate director of surgical services at Penn State Cancer Institute.

“It’s in places like this where the weaknesses of previous, linear systems start to show through and where the flexibility of the Flex Robotic System excels. For example, I can reach up in the nasopharynx toward the skull base without having to split the palate. That you can’t do with other systems.”

Since the beginning of the year, the fellowship-trained surgeons at Penn State Health have completed more than 20 operations using the Flex Robotic System — the most in the nation, notes Dr. Goldenberg.

Better Robotics

The benefits of the Flex Robotic System are numerous:

  • The flexible arm provides a minimally invasive technique to reach difficult-to-access surgical locations.
  • The system is one-third the size of other robotic systems, enhancing mobility and reducing set-up time from 45 minutes to four.
  • The surgeon can sit at the head of the operating table, in close proximity to the patient, rather than across the room.
  • Purchase and operational costs are half those of other systems.

Excellent Outcomes

The Flex Robotic System achieves these advantages without sacrificing benefits that conventional robotic systems provide. The system allows patients to avoid open surgery, resulting in a faster recovery, reduced pain and blood loss, fewer incisions, fewer complications, and shorter hospital stays.

The system, which can be used to treat conditions ranging from vocal cord lesions to a variety of early- to mid-stage head and neck cancers, has extraordinary potential, according to Dr. Goldenberg.

“We’re participating in the first studies to use this technology for transvaginal procedures and seeking FDA approval to use it on children,” he says. “This is the beginning of something great.”

Clinical Evidence

A 2015 study in the European Archives of Oto-Rhino-Laryngology examined outcomes of surgical procedures using the Flex Robotic System. The procedures addressed sleep apnea, vocal fold polyps and carcinoma of the lateral edge of the tongue.

No complications resulted. Researchers noted that the system “provided good visualisation and access to these subsites without compromising safety or success … [and had] advantages including ease of set up and use besides being reliable and safe.”