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Robotic head and neck surgery has since revolutionized our approach, especially in patients with oropharynx cancer. Stanford Head and Neck Surgery spearheaded a multicenter collaborative registry of patients treated with this approach, spanning 11 centers, and demonstrating high rates of disease control and few complications. Currently, a prospective randomized clinical trial, ECOG3311, is underway to evaluate the role of robotic surgery as a means to “de-escalate” the treatment for oropharyngeal cancer. Dr. Holsinger has led the credentialing of surgeons for this study and coordinates ongoing quality assurance. Finally, Stanford is leading the way in pioneering new approaches to robotic head and neck surgery. The initial generation of robotic surgical systems was designed for abdomino-pelvic and thoracic surgery rather than head and neck surgery. The instruments are larger than what would be ideal and have three rigid arms that can be sometimes difficult to place in a confined space such as the oral cavity, pharynx, and larynx. Working in the robotics lab, our surgeons are studying how to implement a next-generation, single-arm flexible robotic system into clinical practice. The new system may enable several conceptual advances for the field of robotic head and neck surgery. Smaller instruments, a flexible stereoendoscope, and better ergonomics facilitate three-handed surgery in the confined space of the head and neck. These technical refinements may facilitate a more accurate appreciation of three dimensional relationships of the pharynx and larynx and perhaps improve the quality of surgery.
Since head and neck cancers and their treatments may impact a patient’s ability to eat and/or communicate, many patients benefit from our speech and dysphagia therapy programs designed to address or prevent problems with communication and swallowing, and to optimize function and quality of life. Our team includes speechlanguage pathologists (SLPs) with specialized interest in the management of communication and swallowing disorders associated with head and neck cancer. Our team has extensive experience in evaluating and treating dysphagia. Our SLPs use a number of tests to assess swallowing; the two we use most frequently are video fluoroscopy and video endoscopy. We use video fluoroscopy to measure swallowing ability from the mouth to the throat and to the esophagus, if necessary. Video endoscopy enables us to look at the swallowing area from above. We then observe a patient swallowing different foods and liquids to see how they travel through the throat. These tests allow us to understand how swallowing muscles are functioning so that we can customize a treatment plan for each individual patient. Our speech-language pathology team also is engaged in clinical research to determine strategies to improve longterm patient outcomes after a diagnosis of head and neck cancer.
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