Health & Wellness ,  News & Innovation ,  Ear Nose & Throat

A step change in ENT surgery

August 31, 2018

Minimally invasive robotic and endoscopic procedures mean an end to scarring and fewer complications for patients


A step change in ENT surgery

Gone are the days when ear, nose, throat, head and neck surgery required huge cuts to the face and surrounding areas to allow surgeons access to hard-to-reach parts of the upper aerodigestive anatomy.

Indeed, with the advent of endoscopy and technology such as robotic arms to perform surgery, the broad speciality of ENT has become much less invasive to treat throat, oral and thyroid cancers, according to Dr Tay Hin Ngan, ENT head and neck surgeon at Mount Elizabeth hospital in Singapore.

“With the surgical robot, we are able to perform TORS—trans-oral robotic surgery—which involves putting an endoscope with various robotic arms through the mouth to remove a cancer in the throat, while previously we had to saw open the jaw to reach it,” he said.

In the past, highly invasive approaches like splitting the jaw was necessary, and could lead to complications. Surgeons would have to cut through a great deal of normal tissue, including the swallowing muscles and portions of the neck, and afterwards replace it with flesh and skin from places like the thigh. Frequently, the procedures would be followed by radiation and chemotherapy together, increasing the risk of further complications.

“Now we cut out the tumour with minimal removal of normal tissue, and because the wound heals with contraction, with surrounding normal structure coming together, nearly normal anatomy is maintained thus preserving sensation and normal swallowing muscles. However, this is not achieved when you put in tissue from elsewhere as sensory nerves are not present in the transplanted tissue,” said Dr Tay.

“Once you remove the tumour, the patient requires less radiation and chemotherapy or may even avoid them completely, so the end result is less toxicity.”

This constellation of benefits contributes to a better chance of survival and better quality of life for patients, who end up eating and drinking more normally after minimally invasive surgery. The treatment duration is also shorter and its cost may be lower compared to more invasive procedures. Furthermore, for stage one and stage two cancers, when doctors are able to remove the whole cancer through surgery, the patient can avoid chemotherapy and radiation altogether.

Aside from head and neck cancer surgery, thyroid surgery has been transformed by minimally invasive procedures. There are various situations when the thyroid or a part of it needs to be removed, such as when the gland produces excessive levels of hormone, if there are nodules suspicious for cancer or definite cancer, or if the thyroid has swollen to compress the airway in the form of a goitre.

“The procedure required depends on the condition, ranging from hemithyroidectomy, removing half the thyroid, to total thyroidectomy, where the entire gland is removed.  Sometimes for more extensive cancer, removal of lymph nodes around the thyroid may be necessary,” explained Dr Tay.

“The traditional way to perform this surgery requires an incision in the neck, from as small as a 3cm up to 10cm for large goiters. For nodules, as long as it’s safe, what we can now offer are scarless approaches by using an endoscope through the mouth, on the inside of the lip, through the armpit, or even behind the ear and into the hairline.”

Conventional surgery leaves a prominent scar in the front of the neck, resulting in much inconvenience for most patients, who would need clothing or accessories to cover these scars.  For some, the scars may even have an impact on their work.  Minimally invasive thyroid surgery avoids this hindrance to the patient in day-to-day life. The process is similar to open surgery and post-surgical recovery is quite straightforward.  It requires patients to stay in hospital ranging from one to five days. During this time, they will usually have tubes coming out of the neck to drain fluid and excess blood. If stitches are used, they will need to be removed five days after surgery. Most patients are back to eating and drinking by the first day, and normal daily activity within one or two days. “Most patients are back to work and exercise after one to two weeks,” Dr Tay said.

Thyroid surgery carries some risks, regardless of the approach, as there are various critical structures surrounding the gland such as the recurrent laryngeal nerves, which control movement of the vocal cords. Inadvertent injury to one side causes hoarseness, while injury to both may cause difficulty in breathing.  However, in the hands of an experienced surgeon, the risk of nerve injury is very low. This applies in particular to minimally invasive surgery, as expertise in endoscopic and robotic thyroidectomy is not widely available. Technology helps minimise risk as well. For example, the da Vinci robot provides a tenfold magnified view and very flexible instruments that help identify and preserve the nerves and parathyroid glands.

As with any other surgery, there are risks of bleeding and infection. In the thyroid area, bleeding is particularly serious because it may result in airway compression, which is potentially life-threatening. Therefore it is important to choose a good aftercare facility following surgery to make sure that if any complications arise, they are recognised early, before they lead to an unsalvageable outcome.

“When considering these surgeries, it is important to consult a surgeon with sufficient relevant experience who can minimise surgical risks and is able to handle more complex cases, including total thyroidectomy and removal of lymph nodes. It is a good practice to find out how many of such surgeries your surgeon has performed because surgeons who have limited or no experience in these procedures may not be aware of what is possible,” Dr Tay advises.

 

An ENT specialist at Mount Elizabeth Hospital in Singapore, Dr Tay Hin Ngan’s clinical interests include using endoscopic and robotic approaches for thyroid surgery, head and neck surgery, advanced sinus surgery, and surgery for sleep apnoea.

Related Articles

Health & Wellness

How to Deal with Obesity & Diabetes?

The prevalence of obesity in the world have continued to increase significantly. It is estimated by WHO that 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.

Read more
Medical Care

Blood delivery drone due to become world’s fastest

New-generation drones slash delivery time of life-saving blood products and medicines in hard-to-reach areas in Rwanda

Read more
Medical Care

Better use your nose

In the long term, mouth breathing might lead to several complications

Read more

Latest Articles

Medical Care

Bladder Cancer: What You Need to Know

Empower yourself with our comprehensive guide to bladder cancer. Explore symptoms, diagnosis, treatments, and supportive resources to safeguard your health.

Read more
Medical Care

Prince Court set to transform brain and spine surgeries with O-Arm Imaging & Navigation System

Revolutionising Brain and Spine Surgery: Prince Court Medical Centre Introduces O-Arm Imaging & Navigation System, Elevating Precision and Patient Outcomes.

Read more
Medical Care

How to Stop Heart Palpitations: 7 Tips and Remedies

Explore effective tips and remedies to prevent heart palpitations. Your comprehensive guide to maintaining a healthy heart rhythm

Read more
Terms & Conditions Privacy Policy
Copyright © 2015 - 2020. All rights reserved.