Patient is cancer free thanks to advanced robotic surgical technology

After experiencing mucus problems in his throat, Chris Smith scheduled an appointment with his doctor. He never thought it would be cancer. Now, thanks to the work of Dr. Michael Sim and IU Health North’s robotic surgery program, he is cancer free.

By Charlotte Stefanski, cstefanski@iuhealth.org, writer for IU Health's Indianapolis Suburban Region

Last August, 59-year-old Chris Smith began experiencing mucus problems in his throat.

He quickly scheduled an appointment with his primary care doctor, but after his exam, he remembers a worried look on his doctor’s face.

Smith wondered what it could be. He had chewed tobacco for 50 years. He also accidentally swallowed a fish bone a few months back and wondered if it had torn something.

But a CT scan showed a mass located way back in his throat on the left tongue base.

It was highly recommended that Smith see Dr. Michael Sim, a surgeon specializing in head and neck oncology and microvascular reconstruction at the IU Health Joe & Shelly Schwarz Cancer Center in Carmel.

“We looked him up on the internet and he looked like a kid,” Smith said with a laugh. “I was like, ‘He’s a boy and he’s going to operate on me? I don’t think so.’ But, my wife talked me into it.”

During Smith’s first visit, Sim performed a biopsy and found that the mass was cancer—squamous cell carcinoma caused by human papillomavirus (HPV).

“It brought tears to my eyes,” Smith explained. “Because I have a lot of unfinished business with my children.”

It was a difficult diagnosis to hear, but Sim quickly put Smith at ease. His cancer was treatable.

“When he told me what kind of cancer it was, that went through one ear and out the other because I really didn't understand,” Smith added. “He told me that I have a good kind of cancer with a high percentage rate of being cured.”

On top of that, IU Health North had recently received leading-edge surgical technology that would make Smith’s treatment plan even easier. His surgery was scheduled for Nov. 9, 2022, a week after his sixtieth birthday.

A new and improved way to treat throat cancer

IU Health North’s robotic surgical program has been quite busy the last seven years, and this fall, teams welcomed the latest single-port robotic surgical technology. It is the first and only hospital in the state to do so.

While several types of surgeries can be performed with the new technology, it has particularly been a game changer for Sim’s work in head, neck and oral cancers.

“It's allowed for better access for tumors deeper in the throat, better visualization and better instrumentation too,” Sim said.

Sim usually takes a minimally invasive approach through transoral surgery, meaning he makes no incision to access the cancer, but instead he works through the mouth.

He explained that some tumors are easier to remove, as they are located near the entrance of the mouth and throat. But others are deeper down in the throat and voice box, in the hypopharynx and larynx.

“Some of these tumors cannot even be removed without the robot,” Sim says. “It's allowing us to take out tumors that we couldn't even reach before.”

Prior to the single port system, surgery wouldn’t be an option for patients with tumors deep inside their throat. Instead, they would need chemotherapy and radiation.

So far, transitioning to the new technology has been a smooth process for Sim and the surgical team at IU Health North. Already, it’s creating more options for patients with deeper tumors—like Smith.

A successful operation

When Smith first heard the phrase, “robotic surgery,” he was a little unsure.

“The robotic surgery was a little bit scary to me, that a machine is going do it,” Smith explained. “I had to sit and think about it a little bit, but you know, Dr. Sim was so professional on the first visit.”

Smith’s son and wife attended that appointment, and he remembers Sim including them on everything. He even let them stand over his shoulder and watch as he examined and took photos of Smith’s tongue and throat, answering any questions they had.

The personal touch was important to Smith. His wife had lost her first husband to cancer, and he knew his own diagnosis would be scary.

Sim assured the family that the robot wasn’t autonomous, but rather, he was in control of it.

“I sit on a console and I look through the camera eyes and navigate the arms. I control every aspect of it,” Sim said. “It's very natural and intuitive. When I move, the robot arms move pretty closely.”

Sim adds that the robot’s cameras are also binocular, giving him a three-dimensional view of the mouth and throat. It’s like being in the throat working without being there directly.

All of this put Smith at ease.

“He told me about the robotic surgery and he made me feel confident. He was so sure of himself and he didn't stutter, he didn't hesitate,” Smith said. “I was looking for that. He knew everything and he made me feel at ease.”

Along with the new technology, Smith was also eligible to be part of a clinical trial that allowed for treatment deintensification, meaning patients could be treated with surgery alone or surgery followed by reduced radiation and the elimination of chemotherapy. The goal is to show that patients can have the same positive outcomes with less toxicity and side effects.

Sim was able to successfully remove the tumor on his tongue, and to ensure the cancer wouldn’t spread, he also removed Smith’s at-risk lymph nodes, which is typically where neck and throat cancers spread.

Since Smith’s lymph nodes were cancer free, he was simply put under observation after surgery and didn’t need any chemotherapy or radiation.

Now four months after surgery, Smith says his tongue feels completely normal, but he’s still experiencing some numbness or pain from the lymph node removal. That’s normal and should go away within a year. He visited Sim for his first PET scan on Feb. 17 to evaluate organ and tissue function. Smith was cancer free.

“I believe in Dr. Sim. I just do. I believe he really knows what he's doing. I've met doctors that are hesitant, but he knows his stuff,” Smith said. “I want to say that nurses in the Intensive Care unit, his team, were outstanding. I feel like he's gave me a second chance.”

It’s National Cancer Prevention Month

February is National Cancer Prevention Month, and when it comes to head, neck and oral cancers, Sim says there are a few signs to look out for.

These cancers typically form a neck mass, and he strongly advises any mass to be evaluated by a head and neck surgical oncologist. He also notes to be on the lookout for trouble when swallowing that won’t improve, or any voice changes or hoarseness that linger. Mouth sores that aren’t healing should also be evaluated.

“If it's not coming and going, but rather coming and staying, worsening and not healing after several weeks, then need to get that evaluated,” he said, adding that smoking and heavy drinking can also increase risks.

As for Indiana University Robotic Head and Neck Surgery Program, Sim hopes to continue providing great service, excellent care for patients and that it continues to grow in size and volume.

He also hopes that in continuing the research program, that patients can have an alternative to chemotherapy and radiation in the future.

“We're the main robotic transoral robotic surgery program for the entire state of Indiana, and we're very proud of our program,” Sim said. “The volume has grown year to year, and I think it's a great option and service that we're able to give to our patients.”