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Improvements in Technology

Program: Skull Base Surgery
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Andrew Schorr:

Let me ask Dr. Hanna. Dr. Hanna, you use endoscopy a lot, where maybe you won't have to do an open surgery but you can go through a scope. Are there some new improvements in that?

Dr. Hanna:

Oh, absolutely. Endoscopy has been around for a while for treatment of nasal problems and sinus problems, and just in the last five years or so we've sort of pushed the envelope a little bit and explored the use of endoscopy in the area of the skull base. The improvements there, as Dr. DeMonte mentioned, is image guidance, and that pretty much applies to endoscopy as well. I think the technology of instrumentation and laser technology and the optics associated with endoscopy make the application in the skull base more and more becoming a reality.

The key to endoscopy really and to minimally invasive techniques is patient and tumor selection. Minimally invasive surgery is not for everybody, and it's not for every tumor, but choosing the right tumor you can achieve in the right hands results that are quite satisfactory with less of the complications or side effects or morbidity associated with the bigger approaches. When we see someone here in our clinic, Dr. DeMonte and I will go critically over all the factors, the tumor type, the tumor location, tumor stage, and we go back and forth and debate about whether endoscopy or open approaches are best, and they're both available and we choose again the best approach based on that.

As far as new advances in endoscopy I think the whole area of surgical robotics is going to lend itself well to endoscopic surgery in the skull base area. Right now tumor removal with endoscopic techniques is not difficult. What is difficult using endoscopy is the reconstruction, the repair, particularly of the brain covering, the tissue we call the dura. And we, Dr. DeMonte and I, have explored the ways to repair the dura using endoscopic techniques with the help of the robot. The robotic arms are such that we can get into very tight spaces and do the kinds of movements that a human hand could do without actually inserting obviously the hand in that, space because that would require an open approach. So that's the advance and the advantage of using robotics in endoscopic surgery is just to push the envelope even further by allowing us deeper resections with safe reconstruction.

Andrew Schorr:

Okay. I just want to underscore that for our listeners. So what you're talking about, you and Dr. DeMonte working together, is to really pave new ground in this sort of surgery, and that's the kind of thing that I hear from hearing today from you and from your colleagues at M. D. Anderson. So for people listening around the world, this is what is really offered at M. D. Anderson and I think gives you the confidence that you really are getting state of the art procedures. And in the case of this use of the endoscope, that's allowing people to have a much quicker recovery, maybe avoid an open procedure, and that's certainly sounds good.

You have this team approach, but there are other members of the team. Gerald, you needed radiation, and radiation in the skull, that's not a trivial thing, not that radiation is at all. But you want to hit the cancer. I know you told me on the phone previously that you felt they were very careful to have targeted radiation.

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