Doctors use transoral robotic surgery to treat head and neck cancer. They may also use it for obstructive sleep apnea. It can often lead to better surgical outcomes than other surgery types.
Transoral robotic surgery (TORS) is a type of robotic surgery for conditions affecting the head and neck. Instead of making an incision in the skin, a surgeon performing TORS accesses the surgical area directly through the mouth.
It is becoming more common. A 2020 study of 73 hospitals found that the use of robotic surgery increased from 1.8% in 2012 to 15.1% in 2018.
Read on to learn more about TORS, including what doctors use it for, what the procedure involves, and how effective it is.
What is transoral robotic surgery used for?
In 2009, the Food and Drug Administration (FDA) approved the Da Vinci system — the specific robotic system used in TORS — to remove both benign (noncancerous) and malignant (cancerous) tumors in the head and neck region .
This includes tumors affecting tissues of the:
Doctors have also used TORS as a surgical option for obstructive sleep apnea (OSA) . It helps open up the space in the back of the throat and may involve removing the tonsils or reducing the size of the base of the tongue.
In some situations, doctors have used TORS to treat thyroid cancer . This involves removing the thyroid gland, which is a procedure called a thyroidectomy .
Who shouldn’t have TORS?
TORS isn’t suitable for everyone. In certain situations, a doctor may suggest a different treatment approach. Your age and overall health play a role in these decisions.
Additionally, your anatomy may play a part. Depending on how the tissues of your mouth and throat are structured, a surgeon may be unable to access the surgical site easily or safely.
When doctors use TORS to remove a tumor, tumor size and location are important. TORS may not be feasible for large or extensively spread tumors. If the tumor is very close to important blood vessels or nerves, TORS may carry too many risks.
How do you prepare for transoral robotic surgery?
Before performing TORS, a surgeon will want to get a better picture of the area where they’ll be operating and of your overall health. To do this, they’ll typically order imaging tests and a variety of blood tests .
As TORS involves operating in and around the tissues of the mouth and throat, it can potentially affect functions like swallowing and speech. Due to this, you’ll meet with a speech-language therapist before your surgery.
The speech-language therapist will evaluate your swallowing and speech. They’ll also discuss how TORS may affect these functions and what to expect during recovery after surgery.
If you’re taking medications, your doctor will give you specific instructions on which medications you need to adjust prior to TORS. Examples of medications that may need to be adjusted before surgery are blood thinners and certain medications for diabetes or pain .
Additionally, you’ll be asked to fast in the hours leading up to TORS. This means you won’t be able to eat or drink anything, save for small sips of water, after a certain point before your surgery.
What happens during transoral robotic surgery?
Surgeons perform TORS while you’re lying down on an operating table. A healthcare professional will give you general anesthesia , which means you won’t be conscious or feel any pain during your surgery.
A device called a retractor will be used to keep your mouth open. It also helps to better expose the tissues of your mouth and throat so a surgeon can access them more readily.
During TORS, the surgeon will be seated at a panel that controls the robotic system that will perform the surgery. This system includes a 3D, high definition camera and robotic arms with different surgical instruments.
The surgeon will position the camera to allow a good view of the area they’ll be operating on. They’ll then use the surgical instruments to perform the operation.
When the operation is complete, the surgeon can use the instruments to close any surgical wounds with sutures . After this, they’ll remove the surgical instruments and camera and take you to the recovery room.
What is recovery like after transoral robotic surgery?
After TORS, you’ll be taken to the recovery room. During this time, hospital staff will monitor your vital signs as you emerge from general anesthesia.
During the first 48 hours after TORS, throat pain and trouble swallowing are common . Medications can help with pain during this time.
A speech-language therapist will also work with you to help you eat and drink safely. You may also have a nasogastric tube to help ensure that you get adequate nutrition and don’t inhale food into your lungs, which can lead to pneumonia .
A nasogastric tube runs through your nose and into your stomach. A healthcare professional will remove it when you can swallow better on your own.
You’ll likely need to stay in the hospital for a few days after TORS. When you’re able to go home, you’ll be given instructions on how to care for yourself and when you can start doing certain activities again. Be sure to follow these closely.
The exact recovery time can vary from person to person. However, you’ll likely need at least 6 weeks off to completely recover from your operation.
A surgeon will also want to have a follow-up with you to see how you’re recovering. During this visit, you may also have additional tests, such as imaging tests.
How effective is transoral robotic surgery?
A 2020 study looked at people with early stage oropharyngeal cancer who had either TORS or nonrobotic surgery. People having TORS had a slightly higher 5-year overall survival rate of almost 5% than those having nonrobotic surgery.
The researchers also found that, compared with nonrobotic surgery, TORS was associated with:
- lower rates of positive margins, which is when cancer cells are still detectable around the edges of the removed tissue
- lower use of chemoradiation after surgery, a combination of cancer treatments
A 2020 review of four studies compared TORS with open surgery for head and neck cancer . When compared with open surgery, TORS was associated with a shorter hospital stay and fewer risks during and after surgery.
However, the study authors noted that they didn’t observe a difference between the two approaches in terms of cancer outcomes. There were no significant differences in positive margins or survival rates.
A 2020 study found that TORS had a similar success and complication rate to other types of surgery for OSA. Its effects on oxygen saturation levels and sleepiness were also similar to those of other types of OSA surgery.
What are the risks of transoral robotic surgery?
As with any type of surgery, TORS carries a variety of risks. These include :
A 2017 study of 122 TORS operations found that 19 people (16%) experienced a major complication that was directly related to the TORS procedure. Older age and a larger area of removal were associated with an increased risk of major complications.
A 2024 study specifically looked at swallowing and speech outcomes after TORS for oropharyngeal cancer. It found that most people receiving TORS had healthy long-term swallowing and speech function after their procedure.
Takeaway
TORS is a type of robotic surgery that may be used for head and neck cancers or for OSA. Instead of making an incision in the skin, a surgeon uses a robotic system to access the surgical site through your mouth.
TORS is generally associated with shorter hospital stays. However, you’ll likely need several weeks at home to recover after TORS.
Potential risks of the procedure include bleeding, infections, and airway blockages. Before deciding on TORS as a surgical approach, be sure to have an open discussion with a surgeon about its benefits and risks.
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