ENT - Touro Infirmary

ENT Surgery in New Orleans

Facilitated by the da Vinci Surgery system

When medication and other non-surgical treatments cannot relieve your symptoms, surgery is the recommended treatment for many conditions affecting the head and neck. These include throat cancer, tonsil cancer, laryngeal cancer, and tongue cancer. African American couple smiling

For many years, traditional open surgery has been the standard approach to treating many head and neck conditions. Yet, with open surgery there is the risk of significant pain, trauma, possible disfigurement, a long recovery, and damage to surrounding organs and nerves. Fortunately, less invasive options are available that allow surgeons to access the target anatomy without a large external incision.

For complex cases, robotic-assisted surgery with the da Vinci® Surgical System may be the most effective and least invasive treatment choice. This approach uses tiny, 1-2 cm incisions – or no incisions at all in the case of throat cancer surgery. Physicians using da Vinci can operate with greater precision and control, minimizing the pain and risks associated with large incisions.

da Vinci surgery may improve your recovery experience and clinical outcomes with benefits such as:

  • Significantly less blood loss
  • No visible scarring or disfigurement
  • No tracheotomy
  • Minimization or elimination of need for chemoradiation therapy
  • Preservation of larynx (voice box)
  • Less risk of larynx nerve damage
  • Fewer complications
  • Shorter hospital stay
  • Fast recovery, return to normal speech and swallowing
  • Equal or better cancer control

Transoral surgery

Transoral surgery is used to treat throat cancer, which is cancer that occurs in the larynx (voice box) and pharynx (throat), including the base of the tongue and tonsils. A neck and throat exam may show the presence of cancer. The sputum (what is coughed up) may appear bloody and a lump may appear on the outside of the neck. Symptoms may include abnormal breathing; coughing; neck or throat pain; or difficulty swallowing.

It is important to be aware of the signs and symptoms of throat cancer since it is highly curable when found early. After a diagnosis is made and the stage (extent) of the cancer has been determined, your doctor will suggest appropriate treatment options. The goal of treatment is to eradicate the cancer and prevent it from spreading. Treatment options include surgery, chemotherapy, and radiation, often applied in combination. In some cases, high-dose chemoradiation is given without surgery. This treatment is non-invasive but the resulting side effects may permanently impact your long-term ability to speak, swallow, and eat normally.

If your doctor recommends surgery, there are two primary types: open and transoral (through the mouth). Tumor size, stage, and location determine the type of surgery required.Traditional open surgery to remove throat cancer typically requires your surgeon to make a long incision through the jaw and throat. Your surgeon may also need to break the jawbone to access the tumor. This approach can result in disfigurement as well as difficulty eating, speaking and swallowing.Reconstructive or plastic surgery may be needed to rebuild the bones or tissues removed during treatment.

Transoral laser surgery may provide a much less invasive treatment option. Using a surgical camera and microscope passed through the mouth, the surgeon directs the laser to the tumor location, avoiding the need for facial disfigurement and tracheotomy. This approach also may minimize or eliminate the need for chemoradiation and its potential side effects. However, surgeons are limited by line-of-sight, instrumentation and optics, which means this approach may not be appropriate for all cases.

If your doctor recommends surgery to treat throat cancer, you may be a candidate for da Vincitransoral surgery, a safe and effective minimally invasive procedure. The da Vinci system enables your doctor to perform this delicate operation for early-to-moderate stage cancer. da Vinciprovides your surgeon with superior vision, precision, dexterity and improved access. It thereby avoids the disfiguring and traumatic aspects of traditional surgery.

Sleep apnea

The Greek word "apnea" literally means "without breath." There are three types of apnea: Obstructive, central, and mixed. Of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently, sleep is extremely fragmented and of poor quality.

Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

The standard breathing device treatment for sleep apnea is to wear a CPAP mask, which improves the opening of the breathing passages by blowing pressurized air into the patient’s nose or mouth during inhalation, overcoming the tissue collapse that creates the apnea. The alternative to CPAP is surgery.

Traditionally, surgery has been centered on a procedure known as uvulopalatopharyngoplasty (UPPP), which includes removing the tonsils and trimming the palate. But thanks to recent technological advancements, minimally invasive surgery with the da Vinci can be used to treat candidates who have tongue base level obstruction causing sleep apnea.

Patients are assessed through in-office examination, review of recent sleep studies, and evaluated with a scope to identify the levels of tissue obstruction. If the tongue base is involved, then the patient is a candidate for sleep apnea using the da Vinci system.

The sleep apnea procedure involves the surgery and one to two days of post-operative hospitalization. Full recovery is expected to take about three weeks. A post-surgical sleep study is obtained three months after surgery.