Minimally Invasive Endoscopic Approach Sheds New Light on Skull Base and Head/Neck Surgery
Dr. Thomas Dobleman who has brought his expertise in head and neck tumor and reconstructive surgery to Omaha and was the first fellowship trained head & neck surgeon in this region, now has brought endoscopic techniques to his approach for select tumors of the skull base and thyroid.
Tumors, congenital and traumatic defects of the skull base have been approached through craniofacial and transfacial approaches, which Dr. Dobleman and Dr. Douglas Long, a neurosurgeon, have been using for several years.
Now through an endoscopic approach in which both surgeons simultaneously work through each nostril, tumors and defects in this area can now be approached without external scars in select cases.
This technique, which should only be used by experienced skull base surgeons, gives new hope to patients, who may have, life threatening tumors of the skull base. This is an area which sits behind the face and under or involving the under surface of the brain.
This technique of minimally invasive surgery has also been applied to the thyroid gland by Dr. Dobleman.
Dr. Thomas J. Dobleman has expanded his use of endoscopic procedures to improve outcomes for his patients.
Dr. Thomas J. Dobleman and Dr. Doug Long are now using a minimally invasive way to remove tumors located at the anterior skull base that would otherwise require either a large cranial opening and brain retraction or disfiguring facial scars.
Instead, in this endonasal, endoscopic approach, a tiny endoscope is advanced through the natural opening in the face, namely the nostril. A variety of tumors can be removed using this technique, in a variety of locations, since the normal sinus cavities of the face are used to maneuver the endoscope to the desired location.
Tumors in the brain and skull base area are slow growing but can invade critical adjacent structures. If the tumor has invaded the cavernous sinus, which contains the carotid artery and the nerves that control eye movements, then the tumor cannot be completely removed with surgery. In this case, the risk of recurrence is high and radiation and/or chemotherapy are usually recommended. If the tumor has been completely removed, the risk of recurrence is lower. In spite of aggressive surgical therapy, the surgeon may leave microscopic cells behind that cannot be seen and may grow into larger tumors over time. Using the endoscopic technique, with its improved visualization over traditional microscope-based surgery, the risk of recurrence can be lower. Dr. Dobleman and Dr. Long are the only surgeons in this region, currently performing such a procedure.
A multidisciplinary approach to the management of diseases is utilized in this area, since the anterior skull base comprises a number of important structures, such as
- The pituitary gland
- The optic nerves
- Carotid arteries
- Brain
- Nasal & sinus tumors involving the skull base
Surgical Procedure
The endoscopic approach is performed through the nostrils. A natural passageway exists at the back end of the nose leading into the sphenoid sinus, which can be enlarged so that the endoscope and instruments can pass into this air-filled cavity. From this region the pituitary gland and adjacent structures and tumors of the skull base can be easily accessed.
Most people go home between 2-4 days after surgery depending on the size of the tumor, the risk of infection. This technique represents further advancement in approaches to surgery of the skull base. The cooperative and team approach of the neurosurgeon and head & neck cancer surgeon provide new hope to patients who have difficult problems in the complex region of the skull base.
Minimally Invasive Thyroid Surgery Can Work for Many Patients
Many patients with thyroid tumors have a new, safe and effective treatment option for Thyroid surgery-- minimally invasive thyroidectomy. This approach can dramatically reduce the size of their neck incisions and speed recovery, according to researchers. Dr. Dobleman is the only surgeon in this area, currently performing such a procedure.
In this procedure patients undergo minimally invasive removal of the thyroid gland, which helps regulate metabolic function or a parathyroid gland, which can affect calcium metabolism. Patients in whom pairing the endoscope with the harmonic scalpel, which coagulates as it cuts, enabled the smallest incisions yet for this approach. Today, careful selection of patients based on factors such as the size of the diseased organ and the patient's anatomy enables him to use this approach.
While most patients with the option prefer a less-invasive approach, the standard approach, which results in a three-to-four-inch incision at the base of the neck, likely always will be needed by some.
With the minimally invasive technique, surgeons cut through skin and muscle to gain direct access. During this surgery, the endoscope enables the surgeon to clearly visualize the surgical site.
This technique, fine-tuned by Dr. Paolo Miccoli of the University of Pisa, Italy, enables the surgery to be performed through an incision less than an inch, by utilizing the endoscope.
Slender instruments also enable surgeons to push aside muscles rather than cut through them. Video monitoring equipment attached to the endoscope magnifies the anatomy so surgeons actually can see better.
"Minimally invasive approaches reduce surgical trauma, recovery time and have a superior cosmetic result." Says Dr. Dobleman.
Thomas J. Dobleman Head & Neck Cancer Institute
Our Mission:
We inspire hope and healing for head and neck cancer patients
and their families through:
- Early discovery
- Comprehensive Care
- Pursuit of a cure
"Amazingly, more than 90,000 Americans each year are diagnosed with head and neck cancer and an additional 800,000 citizens develop skin cancer in the head and neck area," states Dr. Thomas J. Dobleman, founder of the Thomas J. Dobleman Head and Neck Cancer Institute. "To us, cancer care is more than just surgery, radiation and chemotherapy. We treat each patient to heal the body, mind and spirit."
In 2001, more than 4,000 new head and neck cancer cases were diagnosed in our five-state region. Now evidence indicates that pediatric head and neck cancers, second only to leukemia in incidence, have increased 35 percent over the last 20 years. Benign tumors, skin cancers and thyroid cancers in children and adults are also treated at the Institute.
The Thomas J. Dobleman Head and Neck Cancer Institute is dedicated to the diagnosis and treatment of cancer and benign tumors of all kinds that affect the head, skin, skull-base, mouth, throat, and larynx. Our physicians and staff offer coordinated care for patients, from pediatrics through the elderly, who have, or are suspected of having, cancer of the head and neck.
The vision of the Thomas J. Dobleman Head and Neck Cancer Institute is to be a multi-dimensional center offering support to cancer patients, families, friends and the community as they embark on the cancer journey. This Institute will be a place of comfort and solace for those not only dealing with the diagnosis and treatment of cancer but also those seeking information regarding cancer, cancer prevention, and early detection. This Institute will be comprehensive incorporating a full spectrum of care ranging from cancer prevention screening, diagnosis and treatment, to cancer survivorship.
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