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 Expertise and
Research Interests
Minimally
Invasive Surgery
 Salivary Tumours
We
are the only centre in the UK developing minimally
invasive surgery for
benign salivary tumours. My work has shown that traditional invasive surgery
for benign parotid tumours can be replaced by quicker and less invasive procedures.
Our work is now fundamentally altering the current
practice of parotid surgery, changing it from being a major to a minor and less
traumatic procedure.
Head and Neck Cancer
Guy's Hospital has a long history in the practice of head
and neck surgery. I have developed a comprehensive head and neck service which
includes the introduction of minimally invasive techniques, microvascular
reconstruction and 3D image guided surgery. A head and neck database with over
1000 patient records helps promote research into patient care. An
active 
research programme using PET and other tracer molecules to detect squamous cell
carcinomas is currently being undertaken. The outcome achieved is a personal
series of 287 mouth cancers, exceeding the South Thames Cancer Registry results (53%
v 41% crude 5y survival).
Current
Research
The
successful application of minimally invasive techniques to surgery in the jaws
is dependent upon developing sophisticated imaging systems. In order to improve
surgical outcome, the patients face is formed in plastic using CT data. Then
using navigation equipment the surgery can be rehearsed in the laboratory prior
to operation. The object is to get improved surgical margins and to allow
careful planning of the reconstruction of the defect..
We are also investigating
methods of accurately co-localising different image modalities such as CT, MRI
and PET scans to the face in real time. These computer images can be projected
onto the patient to assist endoscopic surgery.
We have just
completed a major EORTC approved head
and neck study on sentinel node biopsy. Patients with early mouth cancer have a
25% chance of tumour spread to the neck at presentation. The current standard of
care is for all patients to have a neck dissection so as not to miss this 25% (
so 75% of patients have an unnecessary neck dissection).
Sentinel node biopsy identifies the 25% of
patients with disease in the neck with an accuracy of 91%
We are evaluating the use of
minimally invasive techniques in the management of salivary stones in a multi
institutional study. In the laboratory we are also investigating the effects of
obstruction on salivary gland function and the factors responsible for
regeneration of the gland.
We are expanding the role of
microendoscopy and developing new equipment which includes endoscope
magnification of images (50x) and computer assisted imaging system.
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