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Talks with Docs: Hilary McCrary, MD, MPH

Read Time: 4 minutes

Video Transcript

As someone that grew up in such a rural area, I know the struggles associated with that and to take care of patients and try and facilitate all their care in one place with such an amazing team, is a great honor.

My name is Hilary McCrary. I am an assistant professor in otolaryngology, head and neck surgery. I’m also a head and neck surgical oncologist and microvascular reconstruction surgeon.

What kinds of head and neck surgeries do you usually perform?

As a head and neck surgeon, I take care of multiple types of conditions, both benign and malignant. I'll treat patients that have oral cavity cancer, salivary gland cancer, larynx cancer, skin cancer, and a variety of other different cancers that can affect patients in the head and neck. That ranges from both taking the cancer out to also doing reconstruction.

What is the single-port surgical robot?

The single-port robot, it's a Da Vinci product. And Da Vinci offers a wide variety of robotic systems for different surgeries. For head and neck surgery, we are operating in a very narrow field all the way in the back of the throat, in an area that's pretty tough to see. 

The unique thing about the single port is all of our instruments are coming kind of through one port. That's why they call it the single port. And you're able to fit up to four different instruments in that area. So, the instruments, they're kind of docked outside the mouth and then we introduce the instruments into the mouth, so it's not like a sterile procedure, there's no incision on the neck using the robot. 

And then there's also this very unique camera that can go into a cobra pose where it changes shape. You can see around very specific and tricky corners in the back of the throat. 

Huntsman Cancer Institute first opened its robotic surgery program in 2011 and remains one of the most advanced and comprehensive in the U.S. today. With 15 surgeons performing in a variety of specialized cancer procedures, they have completed over 5,000 robotic operations to date.

Video ©2024 Intuitive Surgical Operations, Inc.

How does the single-port surgical robot benefit patients?

The benefits are that we're able to have better visualization of very difficult spots to see in the back of the throat. I think ultimately, it's more efficient and the staff are more comfortable. I'm more comfortable using the robot, and it's just a lot easier setup. It leads to a more efficient OR setup, which means the patient gets out of the OR faster and off the table, and out of general anesthetic faster. So, really improved visualization and efficiency are probably the two things. 

Is there a link between HPV and the development of head and neck cancer?

HPV is very much related to the development of oropharynx cancer. The virus lives in the back of the throat. There are certain strains that are associated with the development of cancer, and unfortunately, in a subset of population, those strains can go on to kind of fester and create a cancer in the back of the throat. 

The way that this can be avoided or potentially prevented in patients is that, as a head and neck surgeon, I advocate for everyone to go get their HPV shot. It's FDA approved until the age of 45 years and many patients that may not think they're a candidate are actually excellent candidates. 

What excites you about the future of head and neck cancer care?

In the future, with advanced technology and early detection of oropharynx cancer, we're going to be able to find patients earlier, before they have a disease that's not able to be surgically resected (removed). 

Another really amazing part of taking care of oropharynx cancer patients is there's evolving technology that requires or allows us to draw a patient's blood to determine their circulating tumor DNA levels of HPV, to determine what their levels are before surgery, and then what is their response after surgery. 

And so, by doing a simple lab test, and maybe in the future, a urine test, we're able to detect whether those patients had an appropriate response to surgery and if they're at risk of an early recurrence. 

How has growing up in a rural area informed your practice as a physician?

I grew up in a super rural area. I believe there's still no cell phone service there. It's very remote, and as a kid, if we had any medical needs, we had to drive two hours to go to Grand Junction. It's an honor to work for Huntsman Cancer Institute, which is a catchment area for five states and the surrounding Mountain West. As someone that grew up in such a rural area, I know the struggles associated with that. To take care of patients and try and facilitate all their care in one place with such an amazing team is a great honor.

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