NEWS | May 29, 2019

Robotic surgery for early throat cancer

Minimally invasive procedure at UC Davis Medical Center removes tumor


From jalapeños to ghost peppers, the hotter the better for Susan Fleming. But she never ever eats them.

Robotic surgery patient Susan Fleming shows off some of the world's hottest peppers in her greenhouse. Robotic surgery patient Susan Fleming shows off some of the world's hottest peppers in her greenhouse.

“Not a chance!” declares Fleming. The world’s hottest peppers are among the most popular plants that she and her husband Steve grow and sell from their home in Fair Oaks.

Blazing hot peppers can burn most people’s tongues, not to mention cause significant discomfort for a former throat cancer patient like Fleming. The newly retired retail management specialist is nearly five years cancer free since undergoing robotic-assisted surgery to remove a tumor caused by human papillomavirus (HPV), one of the most powerful human carcinogens.

Transoral robotic surgery removes tumors in a less invasive way

Fleming chose a robotic-assisted procedure, known as transoral robotic surgery (TORS), over the more traditional approach to addressing throat cancer at the recommendation of her surgeon, D. Gregory Farwell, professor and chair of the Department of Otolaryngology – Head and Neck Surgery.

“I couldn’t imagine having my jaw broken,” Fleming said, referring to conventional throat cancer surgery that involves a large incision around the patient’s jaw line. “Plus, I completely trusted Dr. Farwell.”

She described the surgery as “less invasive” and “the best way to go” from her standpoint.

Transoral robotic surgery at UC Davis Medical Center is a minimally invasive procedure used to remove tumors at the back of the throat and around the tonsil or tongue base area where Fleming’s cancer was found. It combines three-dimensional imaging with tiny robotic surgical instruments that are guided by physicians working from a console in the operating room across from the patient.

In Fleming’s case, Farwell evaluated the anatomy of her throat and mouth and the location and size of her tumor. He then determined the most appropriate surgical approach that provided the best possible outcome.

How does minimally invasive surgery work?

“This is a great example of personalized oncology, where we make sure the surgery is likely to benefit the individual patient,” said Farwell. “We work as a team to make sure our recommendation is the best for every individual patient, rather than reflexively treating all patients in the same way.”

TORS enabled Farwell to access Fleming’s tumor directly through her mouth. This minimally invasive technique does not require any external incisions, which can take time to heal and leave lasting scars. Along with the precision of robotic-assisted surgery, recovery times can be faster than external, or open, surgery, too.

Today, Fleming is completely cancer free. She and her husband noted that along with her robotic-assisted procedure, she essentially had a “second surgery” on the same day in the operating room. In this surgery, Farwell used a non-robotic but still minimally invasive procedure to remove lymph nodes in her neck that also were associated with the throat cancer.

Fleming credits Farwell and the entire medical center team with doing a great job of removing all of the cancer and helping restore her health.

Susan Fleming with an armload of plants

“I got great care, and it made me feel like I had a group of people looking out for me,” said Fleming. “I really admire UC Davis Health. It’s that type of care coming from everybody that makes such a difference.”

Innovations in head and neck surgery

Farwell said the robotic surgery program that benefitted Fleming will soon include a next-generation robot, one with a more compact format that could allow even more patients to be eligible for transoral robotic procedures.

He also noted that UC Davis is testing an innovative device that can be used along with robotic surgery to distinguish between cancerous and benign tissue, enabling surgeons to achieve more precise outcomes for their patients.

“It’s a special application for patients with a tumor at the back of their throat,” Farwell said. “In select patients, we can use the robot to gain access to tumors that historically we could not get to less invasively.”

Working with the device’s developer, Laura Marcu, professor of biomedical engineering and neurological surgery, Farwell found a way to combine the fiber-optic tool with the surgical robot to evaluate tissue at the tumor site. The device’s findings are immediate, enabling Farwell to then remove additional cancerous tissue as needed during the surgery.

It’s a biomedical engineering development that could be as hot in the hands of a surgeon as Susan Fleming’s spicy peppers are in the recipes of a chef.