Hospital Performs Area’s First Robotic Surgeries on Oral Cancers(2)

The first transoral robotic surgeries in San Diego have been
performed at Sharp Chula Vista Medical Center and all three
patients who underwent those procedures are recovering well, said
the surgeon who is leading up the effort to help patients beat
early-stage oral cancer.

Advances in robotic surgery prompted the hospital to look for
ways to apply that technology to treat tumors of the mouth and
throat. And thanks to a local benefactor, the institution hopes to
be performing more procedures on local patients.

The hospital is one of fewer than a dozen in the U.S. to offer
the procedure, which was launched thanks to a $1.2 million
anonymous donation to Sharp Chula Vista. The donation helped fund
the acquisition of Intuitive Surgical Inc.s da Vinci Surgical
System, said Dan Dredla, vice president of business development for
the 343-bed hospital in south San Diego County.

We were fortunate that a donor helped us purchase the da Vinci,
said Dredla. Its a costly system, and it was challenging to find
the capital to acquire it on our own.

The da Vinci robot, which combines enhanced 3-D views with
precise incision capabilities, is already being used for various
surgeries at hundreds of hospitals throughout the country and
around the world. However, it was just recently that the U.S. Food
and Drug Administration approved using the da Vinci for the
transoral surgeries, or TORS, procedures on head and neck
cancers.

While Dredla didnt have exact figures on how many patients the
hospital admits with head and neck cancers, its probably 3 percent
to 5 percent of all patients with cancer. Not all of these patients
will have surgery. Sharp Chula Vista admits about 400 inpatients
per year with a primary diagnosis of cancer. Thats just inpatient
admissions hospital staff also treats many more on an outpatient
basis.

Technological Forefront

Dr. Albert McClain, an ear, nose and throat specialist
affiliated with Sharp Chula Vista, said acquisition of the TORS
system is significant.

This is going to allow us to be at the very forefront of
technology when it comes to giving our patients the very best
possible outcomes, he said.

Based on McClains estimate of the number of procedures he
expects to perform, the institution may see a modest increase in
the number of surgeries for oral cancer at Sharp Chula Vista.

Oral cancer is the only head and neck cancer for which the FDA
approves the use of the robotic surgical system. Other types of
head and neck cancers affect the salivary glands, sinuses, pharynx,
larynx, and lymph nodes in the upper neck.

The most common robotic surgical procedures at Sharp Chula Vista
are for urological and gynecological conditions, especially
prostate cancer, uterine fibroids and endometriosis.

In terms of revenue stream, insurance companies do pay hospitals
for treating patients with the robotic system.

Were not generating more revenue with each case that uses a
robotic system, said Dredla. In fact, the cost of the robotic
system actually erodes our profit margin.

Where we (hospitals) benefit financially is by using a surgical
technique that reduces overall length of stay and complications.
That helps with downstream revenue and expense.

Innovative Automation

Named after the famous Italian artist Leonardo da Vinci for his
intricate engineering designs, the da Vinci Surgical System was
approved by the FDA in 2000 and was the first robotic equipment
allowed in U.S. operating rooms. Other San Diego hospitals use the
da Vinci as well.

TORS, a minimally invasive endoscopic technique, targets removal
of early-stage tumors of the tongue base, throat, larynx and skull
base. Traditionally, those cancers have been removed through either
an incision in the neck or through the mouth, which often requires
splitting the lower lip and dividing the jaw.

According to the American Cancer Society Inc., nearly 40,000 new
diagnoses of oral cancer are made every year, but theyre usually
not discovered until they have advanced significantly.

Oral cancer can be hard to catch because the symptoms vary, said
McClain. Some patients experience ear pain or have difficulty
swallowing, while others have no symptoms at all.

Treatment for oral cancer typically includes a combination of
radiation therapy, chemotherapy and surgery, but traditional
surgery involves large incisions which can have devastating side
effects like facial disfigurement and permanently impaired speech,
eating and swallowing.

Pioneers in Surgical Procedure

McClain received his TORS training at the University of
Pennsylvania from the physicians who founded the new procedure and
set up the worlds first TORS program in 2004.

The three initial cases he has treated were not very difficult
cases, but gave McClain and his team an opportunity to work with
the technology. The cases were a benign palate tumor and
early-stage tonsil cancers.

TORS isnt for everyone, but its an important option to have,
McClain said. Its amazing how treatment for oral cancer is
advancing.