Operating theatre with surgeons

Surgical robot helps remove tumour from spine in world first

Image credit: Dreamstime

Doctors and academics based at the University of Pennsylvania have described the first ever robot-assisted spinal surgery: a complex, multi-day procedure, which ended happily for the patient.

The team was challenged to completely remove a rare type of tumour lodged between the spine and skull of a patient, Noah Pernikoff. After a car accident led to Pernikoff undergoing an X-ray, he learned that he was suffering from Chordoma, a type of cancer which grows slowly in the bones between the spine and skull and affects one in a million people each year.

Pernikoff’s doctors knew that surgery would be the best option, although it could prove extremely difficult and dangerous; removal could affect the structural integrity of Pernikoff’s spine and cause permanent paralysis, loss of sensation or issues with fine motor skills. He was referred to the Hospital of the University of Pennsylvania, where a multidisciplinary team saw an opportunity to try this type of surgery with robotic assistance.

The team of surgeons was led by Dr Neil Malhotra, a professor of surgery at the hospital, while Dr Bert O’Malley Jr, a fellow professor, made plans to use a trans-oral roboti (TORS) approach for a crucial stage of the surgery.

TORS is a surgical approach which is minimally invasive and assisted by robots to remove tumours in the mouth and throat. The robot’s arms are placed inside the mouth and controlled by the surgeon from a distance, allowing them to manipulate otherwise unreachable areas.

“This would be the first ever use of a robot in this manner; a rare approach to an already rare and complex case,” said Malhotra. “Our team needed to reconstruct the removed area of Pernikoff’s spine using bone and rods, and that was only the beginning.”

The first part of the surgery – conducted in August 2017 over two days and 20 hours – involved entering the neck and cutting the spine around the tumour. Next, the tumour was removed through Pernikoff’s mouth, using a surgical robot to cut a path in the bone around the tumour, so that the tumour and part of the spinal column could be removed without injuring the spinal cord. Finally, the spinal column was reconstructed using rods and bone from Pernikoff’s hip.

The lengthy surgery was a success, and Pernikoff is already back to work, saying that he is “forever grateful” for the care he received at the university hospital.

“The capability of this technology and procedure is revolutionary,” said O’Malley. “This surgery was groundbreaking and it’s a wonderful example of how versatile TORS is for tumours in the head, neck and now spine.”

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