Robotic revolution

12 June 2018

Pioneering new robotic procedures and proving their efficacy is our responsibility, says Professor Vinidh Paleri, Consultant Head and Neck Surgeon at The Royal Marsden

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Robotic surgery offers patients less invasive, shorter operations compared with open surgery, leaving them with fewer scars and enabling a quicker recovery. The Royal Marsden has the largest and most comprehensive programme of robotic surgery for cancer in the UK, so patients travel long distances to come here. Our aim, and our responsibility, is to inform and shape standard practice throughout the UK and beyond so that patients everywhere can benefit from minimally invasive surgery closer to home.

As one of the few centres in the world to offer transoral robotic surgery (TORS) for patients with radiorecurrent and radioresidual cancer in the head and neck, we have devised a new technique for resection of these cancers. Our research has shown that the TORS technique has equivalent long-term oncologic outcomes to open surgery – without the need to split the jaw and perform extensive reconstruction – and I expect this to lead to a new standard of management for this disease.

Other published research includes a multicentre study that has led to the adoption of robotic tongue base mucosectomy as a diagnostic technique for unknown primary cancers of the head and neck. By using surgical robots to remove the mucosal lining of the tongue base, researchers detected more than 50 per cent of tumours that would otherwise have been classified as cancers of unknown primary. Being able to identify the primary tumour has implications for treatment planning and outcomes.

We have now accrued national consensus from professional bodies for multicentre work to fully explore the role of robotic-assisted tongue base mucosectomy, and will be submitting a clinical trial application to national funding bodies in the near future. I’m also involved in the ComPARE multi-arm Phase III clinical trial, which is comparing different combinations of chemotherapy, radiotherapy and surgery for patients with oropharyngeal cancer.

To ensure that our work can be rolled out to other trusts so that more patients can benefit, we are also training surgeons from elsewhere.

But pioneering new treatments and proving their efficacy isn’t enough. To ensure that our work can be rolled out to other trusts so that more patients can benefit, we are also training surgeons from elsewhere.

The Royal Marsden has seven proctors who train other surgeons to set up a robotic surgery programme and perform robotic surgery at their centres. Surgeons from across the UK and Europe come to us to observe and learn from our procedures, and we visit other centres to provide one-on-one teaching. To date, my team and I have proctored 10 centres in the UK as well as the first centre for transoral robotic surgery in the Nordic region.

We’ve seen a revolutionary change in the management of head and neck cancers over the past decade, thanks to the advance of robotic surgery and new treatments such as immunotherapy. Now it’s time to fulfil the full potential of robots for the benefit of patients everywhere.