Robotic Surgery: Pushing the Frontier in Otolaryngology

They are not the tonsils you usually hear about. Lingual tonsils sit further back in the throat at the base of the tongue, just in front of the larynx. If enlarged, they may cause obstructive symptoms and need to come out. Lurie Children’s is one of a very limited number of children’s hospitals worldwide that can do the procedure with the aid of robotic technology.

“The lingual tonsils are harder to access than the palatine tonsils,” said Douglas Johnston, MD, an otolaryngologist – head and neck surgeon. “Using the da Vinci robot allows us to reach these smaller areas and gain better freedom of movement and improved visualization during the surgery.”

During a more traditional endoscopic assisted surgery, the surgeon uses one hand to hold the camera and the other to hold the instruments. With Transoral Robotic Surgery, or TORS, the surgeon uses the sophisticated, computer-enhanced system to guide surgical tools in the throat where a surgeon’s hands would have limited mobility. “One of the robot’s arms holds the camera that provides the 3-D view of the surgical field,” said Dr. Johnston, “and two other arms hold the instruments and move in a wristed fashion like human hands.” In effect, this gains improved maneuverability and an ‘extra surgical arm’.

Not all patients with traditional tonsil issues are candidates for this surgery though. “Children who have

presented with recurrent sore throats or obstructive sleep apnea will likely first have a tonsillectomy and adenoidectomy to address those issues. If those procedures still have not alleviated the problem, we need to look further,” said Dr. Johnston, “which is often the lingual tonsils.”

The TORS program is multidisciplinary, too, partnering with the Sleep Medicine team to choose the most appropriate candidates.

“Sleep apnea can have medical consequences beyond just irregular, disruptive sleep patterns,” said Dr. Johnston. “If left untreated, it can potentially lead to high blood pressure and increased demand on the heart, even in children. Surgically removing the lingual tonsils, if deemed a cause of obstruction, can help prevent this.”

While lingual tonsil surgery is the main use for the advanced robotic technology currently, the hope is to expand it to other areas, including potentially the larynx for airway reconstruction. “Working in small tight spaces, especially areas that are not easily visible, can be a challenge,” said Dr. Johnston. “This robotic process is able to provide full manual dexterity and a 3-D view of the field, which can provide a better surgical approach. It is a real possibility for other cases with similar visual and space restrictions.”