Robotic surgery beats hidden cancer

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Eleven months into retirement hospital consultant Liam Flood found himself returning to the ear, nose and throat department at The James Cook University Hospital as a patient.

The 67-year-old felt a lump in his neck and when it started to get bigger he knew it could not be ignored – and he also knew just the man to investigate the problem.

After speaking to his GP he was referred to head and neck surgeon Shane Lester, who Liam had mentored back in 2002 and who is now leading the way when it comes to head and neck robotic surgery.

Head and neck surgeon Shane Lester with patient Liam Flood outside The James Cook University Hospital

Head and neck surgeon Shane Lester with patient Liam Flood outside The James Cook University Hospital

The ear, nose and throat (ENT) department carried out an ultrasound guided biopsy of the lump which led to a quick cancer diagnosis, but further investigations were needed to identify the primary source of the cancer.

CT and MRI scans failed to show the cause of the problem, but Shane was able to carry out a biopsy using the one of the trust’s da Vinci robots which revealed a hidden cancer in the base of Liam’s tongue.

Another robotic procedure was then used as part of his treatment to remove the cancer along with an operation to remove his neck lumps and a course of radiotherapy.

Ultrasound biopsies are usually carried out by radiologists, but to speed up the process the ENT team at James Cook has set up a service where they do it themselves. They are the only ENT team in the region to do this and Liam has no doubt that it helped speed up his lifesaving treatment.

“Being on the receiving end of the investigations and three operations made a change,” said Liam, who retired from James Cook in 2018 after 33 years working in ENT.

“I have no doubt at all that the ultrasound guided biopsy makes a huge difference to successful sampling and doing it in ENT greatly speeds up the process.”

Liam knew only too well that in the past his treatment would have involved having his jaw bone broken and then having to endure a skin graft, possible tracheostomy and a long stay in hospital, so he was very open to the idea of robotic surgery.

Shane Lester with one of the hospital’s da Vinci robots

Shane Lester with one of the hospital’s da Vinci robots

“When you say robot you think of R2-D2, but it is just remote controlled,” he said. “It is still the surgeon operating it. And I had great confidence in Shane as I had seen him operate.

“I was sound asleep through the whole thing, but the first time I was home in 24 hours and the second in 48 hours – and that’s only because Shane would not let me go.

“Also, it was good not to wake up with my jaw bone divided and then wired back together as was universal practice when I was a trainee back in the 1970s and 1980s!”

Liam, who lives with his wife Elaine in Great Broughton and has three grown up sons, has now been free of cancer for a year.

He added: “I was very fortunate to have the ultrasound biopsy as quickly as I did and to undergo such advanced robotic surgery – especially when I knew what the alternative was.”

The James Cook team have now completed more than 50 TransOral robotic surgery cases with a 91.5% success rate (35 patients have been assessed at this stage and 32 have been free of cancer).

Shane, who is now leading a trial to review the level of treatment that patients need after this surgery, added: “We are using the robot in ways that permit patients to recover quicker and get on with their lives, spending on average two to three days in hospital and generally going home, eating and drinking after what previously would have been major surgery.

“It has allowed some patients to have their treatment without any radiotherapy and still have the same chance of cure, with less long-term side effects.

“Liam was one of my first ENT mentors – he taught me in my first ever ENT post at the North Riding. It was a pleasure to look after him when he needed me. He has reaped what he sowed!”