Rare tumour removed in world-first robotic surgery

In a first, a robot was used to successfully remove a rare tumour from a patient's neck in a surgery led by an Indian-origin surgeon.

Chordoma is a rare type of cancer that occurs in the bones of the skull base and spine. A chordoma tumour usually grows slowly and is often asymptomatic for years.

In the case of 27-year-old Noah Pernikoff from the US, a 2016 car accident revealed his surprising diagnosis.

Pernikoff became the first patient in the world to undergo a complex three-part, robotic-assisted surgery, which was completed at the Hospital of the University of Pennsylvania in the US in August last year.

Among his injuries from the accident, Pernikoff tore his rotator cuff and had several herniated discs. More important, however, was his post-accident nagging neck pain, which lead to an x-ray that revealed a concerning lesion in his neck, on his cervical spine.

The lesion was clearly unrelated to the accident, and far more concerning than the minor injuries he had endured.

After making a recovery from the accident, a biopsy of the spot resulted in a diagnosis of chordoma.

"I'm lucky because they caught mine early. For a lot of people, if it's not found and treated early, it's lethal," Pernikoff said.

"The doctor said if I hadn't discovered it through the car accident it probably would have kept growing until it came to a point on my spinal cord where it caused paralysis or death," he said.

Unfortunately, while surgery is known to be the best option for chordoma, Pernikoff's was too difficult to resect and he would have to try the second option, radiation with proton therapy.

Chordoma is extremely rare. It affects only one in one million people each year. Pernikoff's specific type of chordoma, located on his C2 vertebrae, is even rarer, making treatment a challenge.

A team led by Neil Malhotra, an assistant professor decided to remove the tumour through a rare and complex spinal surgery approach by using a trans-oral robotic (TORS) approach for the second part of the surgery.

TORS is the world's first group of minimally invasive robotic surgery techniques 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.

The surgery was performed in three parts. First, the neurosurgeons went through the back of Pernikoff's neck and cut the spine around the tumour to prepare for the second stage, removing the tumour through his mouth.

With stage one success, the team used the surgical robot to clear a path so Malhotra could remove the tumour, and part of the spinal column, in its entirety through the mouth.

Finally, the team reconstructed Pernikoff's spinal column, which was now missing an important bone in his neck, using some of Pernikoffs' own bone from his hip and rods to finalise stabilization of the newly built portion of his spine.

Nine months after the surgery, Pernikoff is already back to work.