Dr. Ziv Gil, chairman of the department of otolaryngology, head and neck surgery at the Rambam Health Care Campus in Haifa, Israel, was recently in Scottsdale to give a presentation about an innovative method for removing skull-based tumors.
The Rambam Health Care Campus is affiliated with Technion-Israel Institute of Technology, and its head and neck department is the largest in Israel. It serves patients from Israel and the Palestinian territories, as well as medical tourists from other countries and trauma patients from Syria.
The 1,000-bed academic hospital is the main referral center for head and neck cancer patients in Israel and treats patients who have tumors in the skull base, which was the focus of Gil’s presentation at the North American Skull Base Society’s 26th annual meeting, held Feb. 12-14 at the Fairmont Scottsdale Princess.
The problem with treating patients with tumors in this area is that it’s very difficult to access, Gil said.
Using traditional methods, which involve cutting skin on the face and cutting the jaw to get to the tumors, the surgery has a high morbidity rate. Since there was a need for better ways to treat these tumors using minimally invasive surgery, the hospital has spent the past two years developing a new method to treat some of these tumors, using a combination of robotic surgery and endoscopic surgery.
“I believe this is one of the significant developments in the last several years in skull-based surgery,” Gil said.
This development uses the Da Vinci Surgical System – a robotic surgical system designed to facilitate complex surgery using a minimally invasive approach and controlled by a surgeon from a console – and combines it with the use of endoscopes, medical devices with a light and a video camera used to record images inside a patient.
Initially, the researchers tried to go only through the mouth, but it didn’t work because they couldn’t see the posterior area of the tumor, which made it difficult to take the tumor out, Gil said. So instead they tried a process that involves making a small incision in the neck, putting endoscopes in the neck and reaching the tumor from behind the jaws, separating it from the large vessels that carry blood to the brain and then removing it through the mouth because it’s too big to take out through the neck. (Sometimes, the tumors can be as large as a baseball.)
This technique is unique for two reasons, he said. One reason is because it’s the first time that an operation is being performed endoscopically through the neck – it used to be done through the nose or the mouth – and secondly, because it takes advantage of the Da Vinci robot.
What’s important in this approach, Gil explained, is that instead of cutting the jaw, splitting the jaw or putting an incision in the face, the tumor can be reached through a small incision in the neck and the patient can leave the hospital within 48 hours – without any damage to function, speech or swallowing, and it leaves no cosmetic dysfunctions.
The recovery time for the older method is five to 14 days “and the effect of the surgery is significant,” Gil said.
Gil, an Israeli native who was raised on a kibbutz, received his medical degree and a Ph.D. in neuroscience from Ben-Gurion University in Israel in 2000 and since then has done post-doctorate work in biophysics at the University of Miami School of Medicine, residency in otolaryngology at the Tel Aviv Sourasky Medical Center in Israel and post-doctorate work in cancer research and a fellowship in surgery at the Memorial Sloan Kettering Cancer Center in New York. The Israeli health system is primarily based on training in the United States, Gil said.
After his fellowship, Gil was the co-director of skull base surgery service and then the director of the laboratory for Applied Cancer Research at the Tel Aviv Medical Center before moving to Haifa in 2012 to his current role at the hospital.
“We are the only one in the world now who are doing this approach,” he noted. He said that although these tumors are rare, the hospital has done six of these surgeries in the past year.