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Flex® Robotic System: A New Tool for Treating Head and Neck Cancer


Certain types of oral and throat cancers pose difficult treatment challenges. In many cases, the location of the tumor(s) alone prevents surgical management, forcing doctors to recommend other treatment modalities. Radiation therapy, for example, may not be as successful as surgical resection.

Daniel Karakla, M.D., Matthew Bak, M.D. and Jonathan Mark, M.D. at the Sentara EVMS Comprehensive Head and Neck Center are changing the delivery of care for patients with certain oral and throat cancers. Using the new Medrobotics Flex® Robotic System, Dr. Karakla and his colleagues deliver life-saving surgical care using leading-edge technology.


The limitations of traditional surgical techniques for head and neck cancers

Depending on the location of a tumor, standard surgical management may involve procedures, such as micro-direct laryngoscopy, where surgeons insert miniature instruments into a patient’s mouth to remove masses on the upper portion of the larynx. Additionally, certain lasers or other robots, including the da Vinci® Surgical System, are used if a tumor is located in specific locations in the oral cavity and throat.

However, the use of straight instruments limits these therapies to patients with more easily accessible masses. For those with tumors deeper inside the oropharynx, hypopharynx or larynx, the patient’s anatomy often prevents surgery. If surgeons operate, the procedure is invasive and may pose serious risks to the patient.


Flex® Robotic System eliminates anatomical constraints

The Flex® Robotic System changes the way surgeons deliver treatment by using innovative technology that works with a patient’s anatomy instead of against it. After doctors anesthetize the patient and oral retractors are in place, OR staff maneuver the Flex® Robotic System into position near the patient’s head. Surgeons insert a long, highly articulated and multi-linked, lighted microscope into the oral cavity, advancing it slowly with a joystick to best visualize any masses. Unlike traditional scopes, the Flex® Robotic System scope is capable of maneuvering along a winding path through the throat.

Once in place, surgeons stabilize the scope, making it rigid and preventing any movement away from the surgery site. The scope’s rigidity also provides a stable base for other surgical tools. A set of two working channels flank the scope. Thin, flexible micro-instruments pass through these channels directly to the surgery site. Other robots, like the da Vinci® Surgical System, use remote consoles to maneuver the robotic arms. In contrast, surgeons drive the Flex® Robotic System directly at the head of the bed. An onboard 3D, high-definition visualization system displays the navigation path and surgical site.

The Flex® Robotic System allows direct access to the tongue base, oropharynx, hypopharynx and supraglottic larynx. Dr. Karakla and his colleagues first began using this robotic surgery system in late 2017. Thanks to their surgical expertise and talent, the team is already performing more advanced surgical procedures, including trans-oral supraglottic laryngectomy.


Advanced robotic surgery helps protect patients

The Flex® Robotic System lowers the risk for trauma to the teeth and other adjacent structures. Additionally, because surgery is performed trans-orally, other risks to patients are decreased. These risks include scarring, infection and blood loss. Patients generally have a faster recovery compared to those undergoing more invasive surgeries.

“This is a significant and amazing new tool to help me better care for my patients,” says Dr. Karakla. “It’s a more mobile platform that the OR staff becomes familiar with quickly. The tools that go along with the robot are also more ergonomic and allow me greater access while preserving surrounding structures.”

Dr. Karakla and his colleagues at Sentara EVMS Comprehensive Head and Neck Center are at the forefront of efforts to expand the use of this new robotic system. “We can offer treatment with amazing, personalized care that isn’t available to patients elsewhere,” says Dr. Karakla. Sentara is one of a handful of hospitals nationwide using this impressive new technology, which the Food and Drug Administration approved for head and neck procedures in 2015.