Latest in Head, Neck and Thyroid Surgery

ENDOSCOPIC SKULL BASE RESECTION

The endoscope which has allowed the surgeon to access the deep recesses of the nose has revolutionized the surgical approach to sinus surgery. With the development of more defined scanning options, targetted surgical removal of the deep sinuses and back of the nose can now be done endoscopically. In the past, tumours of the skull base, such as esthesioneuroblastoma, needed combined open approaches through the face and skull. This would involve incisions to the face and scalp done separately by the ENT surgeon and Neurosurgeon. The morbidity from open surgery can now be minimized as surgery can be done via the nostril with the use of telescopes, micro-instruments and knowledge of the anatomy. The endoscopes allow the surgeons to operate off the video system, and both surgeons have realtime and active knowledge of the anatomy. This allows the intricate parts of anatomy such as the vessels and brain to be preserved whilst separating out the tumour.

ENDOSCOPIC RESECTION OF NOSE TUMOURS/CANCERS

The cancers of the back of the nose, such as recurrent nasopharyngeal cancers, that are refractory to conventional radiation and chemotherapy, are now treated with adjuvant surgical removal to allow removal of the nose lining. The difficulty with the recesses behind bony pillars can now be overcome with instrumentation. With the use of endoscopes and equipment that gives access around corners, the deeper and less accessible tumour and tissue can now be effectively removed.

MICROSCOPIC TRANSORAL LASER RESECTION OF THROAT CANCERS

The microscope has been used in surgery for many years. However, the attachment of the laser beam in alignment of the microscope, known as trans-oral laser tumour surgery, has allowed the cutting and removal of deep seated tumours in the throat. This is particularly applied to voice box cancers which otherwise would result open surgery or removal of the voice box. However, due to the small beam size of the laser, the length of the surgery in such cases can be long and sometimes more than one session is needed. The limited access also makes it important to carefully test the boundaries of the removal to ensure a complete removal.

TRANORAL ROBOTIC SURGERY FOR THROAT CANCERS

The robot provides the advantage of "transforming" the surgeons' hands into long slender "hands" yet with the ability to grasp and perform intricate surgery. The robot has built-in endoscopes that allow very close and steady visualization of the anatomy and tumour with a “third” hand and yet allowing the surgeon to operation intuitively with both hands. Special mouth gags has been designed to allow mouth opening and thus access in the mouth, throat and voice box. This combination of excellent optics and precision dexterity gives an advantage over the traditional surgery. The downside of the robot is the cost involvement in its use and the time taken to set up the facility for the surgery. Tonsil and tongue base cancers can benefit from the robotic access which may otherwise needs large open jaw surgery for removal.

ROBOTIC THYROID SURGERY

What was traditionally surgery with a scar on the neck can now in selected cases be done with a robot via a surgical scar in another site eg the armpit. The main advantage for thyroid surgery is cosmetic and the main downside, the cost and duration of surgery. Suitable for patients who are keloid prone and those where the neck scar can have a significant impact on their occupation.