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Buy Addenbrooke’s A Robot: How a new robot will aid cancer patients

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A state-of-the-art surgical robot would transform complex surgeries that often leave patients with life-changing deformities.

Ekpemi Irune, ENT, head and neck consultant Picture: Mel Yeneralski Cambridge Media Studio
Ekpemi Irune, ENT, head and neck consultant Picture: Mel Yeneralski Cambridge Media Studio

A changing demographic that is seeing much younger people develop cancer in the head and neck has accelerated the need for a new surgical robot at Addenbrooke’s. For some patients, the site of a cancer can make it difficult for surgeons to safely operate, and using the surgical robot can enable a surgeon to operate on these cancers more easily.

The machine can access hard-to-reach areas of the body by mimicking a surgeon’s hand movements, making small incisions into a patient’s body and allowing intricate procedures such as tumour removal to be carried out with more precision.

The Covid-19 pandemic has also led to a lot of surgeries being delayed or cancelled, leaving a backlog of patients awaiting both cancer and non-cancer surgery.

Thanks to its minimally invasive approach, patients of robotically-assisted surgery have shorter hospital stays and quicker recovery times, reduced pain, fewer complications, less blood loss and improved outcomes.

Addenbrooke’s Charitable Trust, supported by the Cambridge Independent, has launched a campaign to raise £1.5million for a new surgical robot.

Ekpemi Irune, ENT, head and neck consultant, told the Cambridge Independent: “Robotic surgery will help reduce the problems associated with head and neck surgery in cancer patients, such as life-changing deformity. It can help you get into the nooks and crannies that surgeons can not usually get into without making big incisions.”

Head and neck cancer surgery can be very invasive. Sometimes a tumour in the back of the mouth or throat cannot be easily reached so the surgeon may have to split a patient’s jaw so they can get to the tumour.

The patient has to recover in hospital for several days and they can go on to develop long-term problems with bone healing and chronic pain. This can be very distressing for patients. A surgical robot would be able to access tumours through the mouth with precision.

The use of a robot could also mean patients regain the ability to swallow much more quickly. This is very important as that means they can eat and drink without help, and need less medical care following the operation.

Ms Irune explains: “Over the last few years there has been a particular kind of cancer that’s becoming more and more common. And that is cancer caused by the human papilloma virus (HPV), which tends to affect much younger people. In the past, the typical head and neck cancer patient tended to be older and a lifelong smoker... Now what you have is a 40-something fit and well professional with young kids, who presents to you with cancer – HPV cancer. They’re often not a smoker and may not even drink either, so the demographic has changed. They’re all patients who need to get back to work, to support their families, to be active in life in society and be interacting.”

She continued: “These younger patients tend to present with tonsil cancer. We also have tonsil cancers in the ‘traditional’ patients and will usually give them chemotherapy and radiotherapy in huge doses. This has the potential to cause long-term problems to do with swallowing and dry mouth. Sometimes, patients get an inflammation of the bone with a chronic bone infection in the jaw, difficulty opening the mouth, as well as changes to the skin and stiffness in the neck.

“All of these things occur because of the radiotherapy and chemotherapy that we have to give them to achieve cure.

“However, we’ve realised with research all over the world that in patients where the tumour is caused by the HPV they do better, and therefore the thinking is that you can de-escalate their treatment and you don’t have to give them the sledgehammer-type treatments that we give to non-HPV patients.

Ekpemi Irune, ENT, head and neck consultant Picture: Mel Yeneralski Cambridge Media Studio
Ekpemi Irune, ENT, head and neck consultant Picture: Mel Yeneralski Cambridge Media Studio

“That’s where robotic surgery comes in because, in patients like this, disease is often low volume and you can cut the disease out with the robot. You can often spare them higher doses of radiotherapy in favour of lower doses and, in some cases, you can spare them the morbidity of chemotherapy completely. So that means they have fewer long-term complications.”

Ms Irune continued: “The other group of patients are those who have had treatment in the past – for cancers in the back of the throat who present with recurrent disease.

“They’ve had chemoradiotherapy already and most of the time cannot have any more. In these patients, surgery will be beneficial Traditionally, in some of these patients, we would often have to perform a huge operation to break the jaw, so that you can get access to the back of the throat to ensure adequate clearance of the disease.

“Achieving adequate tumour clearance often results in leaving a big defect with all the tissue we’ve taken away, and so you have to borrow a bit of tissue from another part of the body, plug it into the defect, so the patients can swallow and eat afterwards.

“To avoid splitting the jaw, robotic surgery gives you the access to do all of this transorally, so through the mouth. The surgeon can deploy the arms of the robot through an open mouth, and can cut the tumour out without having to break the jaw."

Not only is the traditional surgery exhausting for the surgeon but it also means the patient is under anesthesia for a much longer period of time.

Without the use of a robot, Ms Irune has to send patients who require robotic surgery to the Royal Marsden Hospital in London.

“It’s tiring for families to have to do this. It’s mentally challenging having a tumour of any kind, whether it is cancerous or benign. Being diagnosed with a tumour already has a psychological burden of its own. This is made even more difficult for the patient when one adds in the fact that the individual then has to travel out of their comfort zone, has to meet people they don’t know, has to worry about potential expenses. There is the additional anxiety of being away from loved ones, who can’t just pop around the corner to see you in the hospital. Overall, the experience is really unpleasantly intense for the patient and their relatives.

“And then there is also the effect on a surgeon like myself who has trained to do robotic surgery. It can be quite disheartening not to be able to do it as regularly as I would like here at Addenbrooke’s in order to provide all the care that I can for our patients.”

By supporting ACT’s campaign to purchase a surgical robot, you could help ENT patients get back on their feet much sooner after an operation.

Ms Irune added: “The kind of head and neck cancer we’re seeing more of now can happen to anyone. You don’t have to be a smoker, you don’t have to drink alcohol. It could be you or me.

“Would you or a loved one want a prolonged stay in hospital or huge doses of radiotherapy or chemotherapy? Or would you rather have less treatment and shorter stays in hospital? Robotic surgery is not without risk in itself but it will do a lot of good for our patients, improving survival, disease control and their experience of living through head and neck cancer.”

Visit helpyourhospital.co.uk/robot.

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Buy Addenbrooke’s A Robot: Support our £1.5m campaign to improve surgery for patients

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