11 February, 2013 12:28PM AEDT

Using a robot alternative for throat cancer surgery

The Da Vinci surgical system (robot) is reasonably new to Australia and is mostly being using for prostate and gynaecological surgery. At Macquarie University Hospital in Sydney, surgeons from other specialities are also using the robot, including in this case for throat cancer. Carol Bryant is the CEO of MUH. Speech pathology is also a crucial part of recovery for patients after this sort of surgery - not just for speech but for swallowing safely. Jenny Cole-Virtue is a Speech Pathologist at MUH.

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The Da Vinci robot in place, with assistant surgeon situated at Brad Keeling's headThe Da Vinci robot in place during Brad Keeling's surgery for throat cancerDr Jonathan Clark during Brad Keeling's surgeryDr Jonathan Clark using the Da Vinci console during Brad Keeling's cancer surgery

CAROL BRYANT: At Macquarie University Hospital we purchased the Da Vinci robot about 12 months ago and it's really a leading edge technology.

Years ago they brought in keyhole surgery in which everybody talked about laparascopic surgery. The robot is the next step from that in that it allows minimal scarring for the patient but fantastic vision for the surgeon while they're actually operating so they get a three dimensional view of what they're looking at.

The arms are attached to the patient and the doctor uses a console in the corner where he gets a 3D view of what he's operating on.

It's used predominantly for urological surgery - prostate cancer, then for gynaecological surgery - hysterectomy, and here we're also using it for cardiac, head and neck and colo-rectal surgery. A person can have a major surgery with a couple of little holes in the abdomen and they go home usually two days later.


There are six or seven now in NSW but at Macquarie University Hospital we have the broadest spectrum of the program. Most people would just be doing urological surgery and some gynaecological surgery but we're doing the whole spectrum. So for someone with head and neck surgery where they might be actually cutting into the face, removing the bottom jaw, major cuts, what you've got here is an approach with the robot arms, minimal scarring, minimal actual trauma but a fantastic outcome removing the cancer or whatever they're looking for but able to go home in a couple of days.

It's the view that they get, the way the surgeon can see. When they're using the robot arms at the console in the corner they actually get three dimensional view and can see things much more clearly than in the traditional laparoscopic view and then from the open view where there's a major cut, so they can see incredibly well with a minimally invasive technique. It doesn't have that same trauma of major scars and recuperation over a number of weeks.

CAROL DUNCAN: New health and medicine technologies are expensive, why make the investment in the Da Vinci system?

CAROL BRYANT: It is over a three million dollar investment, but here at Macquarie University Hospital we're set up a bit differently. We're the first private teaching hospital in Australia on the campus of a university.

We're set up to do teaching, research and amazing clinical things like the robot and other things that we do, so our aim is to teach post-graduate medical students, so they need the latest technology, the broadest range of technology, to move into the future with what's going on.

The robot is used extensively overseas. I think over about 80% of hysterectomies and prostatectomies in the USA and Europe are done via the robot, so we'll look back in 10 years and I'm sure it's what we'll be doing here.

CAROL DUNCAN: Are we slow in adopting new technologies in Australia?

CAROL BRYANT: We do tend to take a while in Australia (to adopt new technologies) but in some ways there are advantages to that. We're learning all the time from the new technology that's being adopted overseas and many of these techniques and equipment come from overseas so we find that our doctors are going overseas to do robotic fellowships and come back with that knowledge.

That's what we aimed to do in the beginning. We bought the robot with the idea of setting up a robotic surgery program. Our doctors then approached us, went overseas to do their training, brought proctors mostly from overseas to do the first few cases with them and we are doing cases across all of that spectrum. It's really adding an amazing choice for our patients with a centre of excellence if you like, where our aim is to continue to do it across that whole broad spectrum and not many others are, so it's really setting us up with a centre of excellence here.

The good thing about this sort of development is that doctors are working in teams. A few of the doctors may train in the speciality and one will assist while the other works and vice versa, both within and across specialties. You'll have both of them trained, but one of them assisting the other so they're gaining their expertise together.

With all of them we have proctors, specialised people who've done multiple cases elsewhere. When we started urological surgery we brought some very experienced people from South Australia, but when we started the head and neck surgery we brought people from Korea so the expertise comes to us to help our doctors gain similar expertise.

I know when we sent some of our colorectal surgeons to Korea they just came back saying, 'Oh, I can't believe this, they're doing so many cases!' and it actually often converts them to the new technology.

It must be hard, even for an expert to go 'I'm really going to have to change my skill set here', and then they go and see experts doing it who've got experience, they've got excellent outcomes for the patients, and it really converts them to the technology.

It may not in some cases extend life, but it will definitely extend quality of life, so it really is an amazing technology.

JENNY COLE-VIRTUE: My role with Brad will be to ensure that after the surgery he's able to swallow safely. He's having some of the base of his tongue resected and that may affect his swallowing so we want that to be safe to ensure that liquids and fluids are able to pass into his oesophagus and not into his lungs.

In terms of his health and safety, it's extremely important, obviously speech is also extremely important and we'll be addressing those issues should they arise post-surgery.

Swallowing is something we take for granted, so how do we retrain someone to swallow safely.

We all know how to swallow, we all have a reflex that allows us to do that and tongue movements that allow us to move food around in our mouth. If you have a problem with your tongue for whatever reason whether that be from stroke, from a neurological cause, or surgery from a head and neck oncology perspective, then sometimes we need to modify the textures that you have that might make it easier for you to move food around in your mouth and to propel it backwards to elicit the swallow reflex.

Speech pathologists work across a number of populations and it's not just swallowing, it's speech and language and voice and fluency.