For years, Richard Parks used exacting precision in his line of work in order to help safeguard the lives of others. Now he would need that same commitment to precision and perfectionism to help preserve his.
Parks had trained to run power plants in the U.S. Navy and operated them for commercial utilities across the country, eventually certifying as a nuclear test engineer. In another portion of his career, he owned a company that used lasers and precision instruments to calibrate measuring devices with tolerances up to 2/10,000 of an inch.
Parks had just retired from the power industry with his wife Donna in Grass Valley, Calif. when he received a shock: he'd developed throat cancer. To optimize his chances of survival, Parks chose to have the cancerous tissue surgically removed. But the neck is a particularly delicate location, marbled with an intricate network of blood vessels, muscles and nerves linked variously to both survival and quality of life.
If surgeons weren’t aggressive enough in removing Parks’ cancer, it could regrow and spread again later. If they were too aggressive, they risked either nicking his main blood vessel or damaging his ability to breathe, eat, drink, speak, smile or move his arms — all side effects that he dreaded.
Success would again be measured in the tiniest of measurements.
“Everyone was telling me — including friends who were doctors — that I would not be able to raise my arm over shoulder height again, that the right side of my face would be numb, that my lip could hang as if I had palsy,” after the surgery, Parks said. “And I was prepared to live like that.”
He wouldn’t need to, thanks to the delicate handiwork of an internationally renowned surgeon and modern minimally invasive robotic techniques. But his operation also had a broader mission as well: it helped UC Davis researchers test new laser-based diagnostic technology that someday may dramatically enhance precision cancer care even more.
Pursuing pinpoint accuracy in cancer treatment
A magic wand
Bioengineer Laura Marcu developed a laser light device she hopes will dramatically increase both accuracy and certainty in cancer surgery.
- Magic wands and other innovations to find cancer
- Researchers hope to improve precision
- Laura Marcu biography
A steady hand
Gregory Farwell combines minimally invasive robotic surgery and delicate conventional surgery to minimize side effects. In 2010 he led one of the most complex transplant surgeries ever performed.
Delicate touch required
After investigating treatment options near home and in the Bay Area, Southern California and Arizona, Parks turned to UC Davis head and neck surgeon Gregory Farwell to remove his tumor. Farwell, director of head and neck oncology and microvascular surgery who led the world’s second successful larynx transplant at UC Davis in 2010, planned a combination of robotic and traditional procedures.
The two-part operation was challenging but successful, Farwell said. Although the main tumor’s location near the voicebox pushed the limits of the equipment, Farwell was able to use a da Vinci® robotic surgical system to remove the cancer through the mouth, avoid splitting the lower jawbone and other collateral damage associated with traditional procedures. UC Davis was the first medical center in the Sacramento region to acquire the highly sophisticated robotic equipment in the early 2000s.
The manual surgery to remove Parks’ cancerous lymph nodes was even more complex, and required an especially delicate touch to avoid damaging the important nerves that control face and arm movement, as well as the carotid artery which supplies blood to the brain.
“Richard’s surgical outcome was exceptional, and he’s undergoing the additional necessary treatment to give him an excellent prognosis,” Farwell said. “Our robotic surgery and neck (procedure) allowed for complete tumor removal, plus the advantage of having all of the removed tissue analyzed, which helped us individualize his treatment after surgery with radiation and chemotherapy.”
Farwell removed most of the lymph nodes on the right side of Parks’ neck as well as his right tonsil, a section of his throat and a section of tongue. As expected, for a short while after surgery, Parks was hoarse and somewhat stiff — but he suffered no dramatic impacts on his ability to talk, smile, eat or drink.
Parks also chose UC Davis for his follow-up radiation and chemotherapy, in hopes that academic expertise will also help to prevent excess damage to the bodily functions that were preserved by Farwell in the surgery.
“What amazed me was that in this surgery, knowing that the cancer was up against my carotid artery and wrapped around a lot of the nerves, I did not have any nerve damage,” Parks said. “It's amazing because that's an extreme amount of skill. It’s well within the standards of care for that type of (cancer) surgery to sever those nerves, and Dr. Farwell did not.
“I have full use in my arm, I have a little bit of stiffness, but I feel everything. I can't believe it.”
“Richard’s surgical outcome was exceptional, and he’s undergoing the additional necessary treatment to give him an excellent prognosis. Our robotic surgery and neck procedure allowed for complete tumor removal.”
— Gregory Farwell, M.D.
A magic wand
Parks’ operation also allowed Farwell and UC Davis biomedical engineer Laura Marcu to gather data about the performance of an experimental device that could literally give surgeons of many stripes the benefit of laser precision in the future.
Developed by Marcu, professor of biomedical engineering and neurological surgery who also leads the UC Davis Comprehensive Cancer Center’s Biomedical Technology Program, the laser light probe is called multispectral scanning time-resolved fluorescence spectroscopy in official terms. It will enable the surgical robot to instantly scan tissue during surgeries and assess whether it’s malignant.
Readings can potentially be used in two ways, Marcu said. The first is to help surgeons better delineate where they should cut before making an incision and removing tissue. That precision is especially important for areas like the head and neck and the brain, where surgeons lack flexibility.
The second application is to examine the “margins” or border around areas where cancer has been removed. Current processes rely on a surgeon’s vision and expertise in order to identify sites for biopsies at three or four points around the border, which are then sent to a laboratory for up to 30 minutes of processing while the patient waits on the table in mid-operation.
That’s slow, but more importantly, subjective, since the biopsied areas must serve as a representative sample of the rest of the border. Marcu hopes that laser light of very low intensity can instead be run around the entire border bit by bit to instantly, completely and objectively determine whether cancer is still present.
“If this technology works in a clinical sense, you have the potential to have the surgeon make a more objective decision about the margins and where to cut and how much, and to see if there’s any residual tumor left in a few seconds” Marcu said. “Broadly speaking for the overall outcome of the patient, we hope it will improve survival rates while preserving important bodily functions as well.”
Targeting other cancers
“Broadly speaking for the overall outcome of the patient, we hope this will improve survival rates while preserving important bodily functions as well.”
— Laura Marcu, Ph.D.
If results for Marcu and Farwell continue to be promising for robotic head and neck procedures, ultimately the technology’s path to widespread release and adoption would likely involve commercialization by a medical device manufacturer and further clinical evaluation.
Marcu and colleagues are also testing the performance of fluorescence emission without a robot during surgery for brain cancer, the malady originally targeted in her research. She hopes to gain funding to launch studies on potential application for breast and prostate cancers as well.
For his part, Parks — the retired nuclear engineer — said he is glad to help research on fluorescence spectroscopy along.
“You hope you not only increase the survival rate of the person, but also minimize the potential for side effects and make life easier for them,” he said. “I'm a firm believer in technology. I figured I didn't have anything to lose and the practice of medicine had everything to gain.”