Trans-Oral Robotic Surgery

Traditional surgery for cancers affecting the throat or mouth can present certain challenges when it comes to accessing the affected area. A newer alternative that may be used by ear, nose, and throat doctors specializing in cancers of this nature is trans-oral robotic surgery (TORS).

• It’s a type of surgical technology that involves the use of a computer-enhanced system to provide added guidance.
• The system allows for an improved ability to manipulate tissues and reach affected growths in corners and other spots that would normally be difficult or impossible to reach.

The surgeon is seated in a special unit where the controls are located. The doctor is then able to control the arms of the robot, which will manipulate tissues within the patient’s mouth, from the console. The robot used has a built-in 3D camera along with two surgical arms. One has a cutting device, and the other arm has a grasping device.

During the procedure, an assistant sits by the patient. The role of the assistant is to immediately provide any help that may be needed as the surgeon guides the robot. Special instruments and retractors are used to ensure optimal exposure and access for the robotic device. During the surgery, the two surgical arms are placed into the mouth at precise angles. Normal tissues around the margins of where the tumor was located are collected by the device and frozen for analysis. If these tissues are free of cancer cells, the procedure is considered complete.

TORS is intended for use in areas of the throat that are difficult to access, particularly the base of the tongue around where the tonsils are located. There have also been instances where TORS has been used in parts of the soft palate and posterior oropharynx wall (the oropharynx). Some surgeons have used this type of robot-assisted surgery to perform partial removals of the larynx (laryngectomy).

The primary advantage of TORS is the ability to reach areas of the mouth in a way that’s less invasive. In some situations, robotic surgery may avoid the need to switch to an open procedure to reach the affected area safely. Surgeon-assisted robotic surgery may also allow access to parts of the head and neck region that would otherwise be inaccessible. Post-operative problems could also be minimized if additional tissues and structures won’t have to be removed to access the tumor. However, TORS does not eliminate the need for traditional open surgery for every instance of throat or mouth cancer, especially for larger tumors or cancer affecting multiple areas.

For situations where it makes sense to use trans-oral robotic surgery to remove a tumor in the throat or mouth, patients may benefit from shorter recovery times and fewer complications. Another possible benefit of TORS is that follow-up reconstruction and cosmetic procedures to restore appearance and function in the treated area may not be necessary. Depending on the extent of the cancer, follow-up chemotherapy and radiation therapy, however, may still be recommended after TORS.