An x-ray revealed a lesion in Noah's neck on his cervical spine, a biopsy caused the doctors to diagnose it as chordoma; one of the rarest tumours ever.
In 2017, a surgery was performed at the Hospital of the University of Pennsylvania, which made science fiction a little closer to reality. Dr Neil Malhotra, a doctor of Indian Origin, performed the world’s first minimally invasive robotic surgery along with his team.
Noah Pernikoff, a resident of New York, met with an accident in 2016. Pernikoff tore his rotator cuff and had several herniated discs in his spine. But it was a pain in his neck that that led to a curious discovery after the accident.
The pain had nothing to do with the accident and made doctors suspicious. After an x-ray revealed a lesion in his neck on his cervical spine, a biopsy caused the doctors to diagnose it as chordoma.
Now, chordoma is a type of cancer that occurs in the bones of the base of the skull and the spine. A chordoma tumor usually grows slowly and is often asymptomatic for years. It is very rare, with one in a million people being diagnosed with this condition each year.
Pernikoff’s specific type of chordoma, located on his C2 vertebrae, is even rarer, making treatment a challenge. And after careful review of his case, doctors custom-made a treatment plan, one which did not include the conventional radiation but a robot-assisted surgery.
Neil Malhotra, Assistant Professor of Neurosurgery and Orthopaedic Surgery and the Vice-Chair of Operations at the Department of Neurosurgery, put together a multidisciplinary team of physicians to treat Pernikoff’s chordoma.
The team determined to perform the surgery in three parts. Firstly, neurosurgeons would go through Pernikoff’s neck and cut the spine around the tumour. This would help them prepare for the second stage of removing the tumour through his mouth.
It was at this stage that they would use a trans-oral robotics (TORS). TORS is the world’s first group of minimally invasive robotic surgery technique to remove benign and malignant tumours of the mouth and throat.
“This would be a first ever use of a robot in this manner—a rare approach to an already rare and complex case,” Malhotra said to Penn Medicine. He added, “Our team needed to reconstruct the removed area of Pernikoff’s spine using bone and rods, and that was only the beginning.”
The surgery was not simple as it carried with it the risk of complications such as bone and tissue breakdown, loss of the sense of smell, fine motor skill issues, and complete paralysis. Malhotra said, “If we couldn’t remove the entire tumour, it would likely grow back, perhaps more aggressive than before.”
And after a gruelling two days of surgery, spanning over 20 hours, the team had found success. Nine months later, Pernikoff was already back to work in commercial contracting. He says he is forever grateful for the car accident that revealed a tumour.
Bert W. O’Malley Jr., MD, who assisted with the surgery said, “This surgery was groundbreaking, and it’s a wonderful example of how versatile TORS is for tumours in the head, neck, and now spine.”
Truly a robot-assisted surgery is a benchmark of how far we have come in healthcare. And with the expertise of doctors such as Dr Malhotra, the advancement is sure not to stop.
(Edited by Shruti Singhal)
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