Robotic surgery has transformed how throat cancers are treated. In this video, ENT surgeon Dr John Charles Hodge, who has been performing robotic surgery since 2009, explains how it works and what makes it different from traditional surgery.
What is robotic surgery?
In robotic surgery the surgeon still performs the operation, controlling robotic instruments from a console. For throat surgery, a camera and instruments are passed through the mouth, so the surgeon can reach areas that are hard to see and access with standard instruments.
Key points from the video
- The surgeon is still operating. The robot doesn’t operate on its own. The patient is under general anaesthetic, a camera and two instruments go in through the mouth, and an assistant holds two more instruments.
- A much better view. The angled 3D camera sits inside the mouth, giving depth perception and a view that standard headlight surgery can’t match.
- Instruments that move like a wrist. The instruments are articulated like a human wrist and move intuitively, unlike standard instruments that move in the opposite direction to the surgeon’s hand.
- Steadier, finer movements. The system filters out tremor and scales down movement, so a 3 cm movement by the surgeon can become a 1 cm movement of the instrument.
- Beyond cancer. Robotic surgery has been one of the most significant changes in throat cancer treatment in the last 20 years, and Dr Hodge also uses it for some sleep operations.
Video transcript
Hi, my name is John Charles. I’m an ear, nose and throat doctor, and I’m going to talk to you today about robotic surgery. I’ve been a robotic surgeon since 2009, and it really has changed the landscape of throat cancers.
Now, robotic surgery is not the robot doing the operating. It’s still me doing it. The setup is essentially that the patient’s asleep under general anaesthetic. There are three endoscopes that go into the patient’s mouth: a camera and two instruments. There’s also an assistant holding two instruments, so essentially it’s a four instrument technique. I’m sitting in the corner of the room, where I get a view from the endoscope.
Normally, if I’m operating in a mouth, say to take out a tonsil cancer, I’ve got a headlight on. It’s like being in a room with a window, and that’s the view you get looking out. With an endoscope actually inside the patient’s mouth, you put your head through that window and now you can look up and see the walls. So the view is much better. The camera is also angulated. It’s a 30 degree camera, so when it goes into the patient’s mouth I can see up at the tongue.
The problem then is still the standard instruments. It’s like a pair of scissors. It can cut that way or this way. It’s also counterintuitive, so if I move down, the instruments move up, and if I move to the right, the instrument moves to the left. With the robotic system, the instruments are distally articulated, so it’s like a human wrist. I can move in any direction, which also means I can cut upwards, and it’s intuitive. If I move right, it moves right. If I move left, the instrument moves left.
So I’m in the console. I’ve got a three-dimensional view, which means I get depth perception. It also filters tremor, which means that if the surgeon’s got a shake, that isn’t reproduced in the instruments. It also de-amplifies movement, and it makes you ambidextrous. Most ENT surgeons are fairly ambidextrous, because we do tonsillectomies with one hand and then the other. De-amplifying means that for every centimetre I move, the instrument moves much less. Often I’ll set it to one to three, so I move 3 cm and it only moves one. It makes you much less clumsy.
So this has been one of the most significant changes to the cancer arsenal in the last 20 years, and I’ve been very lucky to be part of that very, very early on. We also use it for other non-cancer operations, so I use it for sleep operations as well.
Hopefully you found that helpful.
Talk to Dr Hodge about robotic surgery
If you’d like to find out whether robotic surgery may be an option for you, book an appointment or get in touch with the rooms.
This information is general in nature and is not a substitute for personalised medical advice. Please speak with your GP or specialist about your individual situation.