What kind of surgeon do you call in when you’re dealing with an incredibly complex, rare procedure involving a cancerous tumor which affects just one in 1 million people each year? Quite possibly a robot one. At least, that is what neurosurgeons and otolaryngologists at the University of Pennsylvania School of Medicine did when they performed the world’s first robot-assisted spinal surgery. The complex procedure utilized cutting-edge robotic arms to remove a tumor in 27-year-old patient Noah Pernikoff’s neck — through his mouth.

The groundbreaking surgery took place at the Hospital of the University of Pennsylvania, and required more than 20 hours in the operating theater, carried out over the course of two days. Due to the placement of the tumor in the patient’s neck, doctors were worried he risked permanent paralysis should something go wrong. In addition, if the entire tumor was not removed, it would likely grow back, perhaps even more aggressively than before.

The operation was performed in three phases. Firstly, neurosurgeons entered through Pernikoff’s neck and cut the spine around the tumor. A team of three head and neck surgeons then used the surgical robot to remove the tumor through the patient’s mouth. Finally, Pernikoff’s spinal column was reconstructed using a hip bone and additional rods for stability.

The use of the trans-oral robot (TORS) meant that it was possible to switch from relying on radiation therapy to actively removing the tumor by operating on it. “There are two components that make this work so exciting,” Dr. Neil Malhotra told Digital Trends. “One is that it permits us to switch from palliation for certain types of tumors to, in some cases for the first time, seeking cures. For the second point, this approach is less traumatic for the patient, which means a better recovery.”

Although news of the surgery has only now been made public, it took place in August last year. Nine months later, Pernikoff is now fully recovered and back at work. “We are still trying to determine where and when robotics — or cobotics — can help patients in terms of outcomes and cures,” Malhotra continued. “The case discussed is a new indication.”

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