Trans Oral Robotic Surgery
Until recently, patients with certain early-stage head and neck cancers have had few surgical options.
Conventional open surgery for throat or oropharyngeal cancer, for example, has been very successful in treating patients with early stage cancer. But it is so invasive that patients are frequently left disfigured and/or have permanent difficulties eating, swallowing and talking.
Transoral laser surgery is less invasive, and uses a scope and laser inserted through the mouth to treat the tumor. But because of limited visibility in many areas of the throat, it is often not an option.
Fortunately, an advanced, minimally invasive alternative is now available. TORS (Trans Oral Robotic Surgery) provides excellent viewing of the surgical area and improved tools that work well in tight spaces.
Although available at only a few medical centers across the country, TORS is proving very successful in treating people with early-stage throat cancers.
Robotic procedures are done in an operating room with a specially trained surgical staff. Patients are under general anesthesia, and are constantly monitored by an anesthesiologist.
With TORS, there are no incisions. Surgery is done entirely through the mouth using the daVinci robotic system.
During the procedure:
- A retracting instrument is inserted into the mouth to open and extend it
- A viewing scope is inserted
- Miniature instruments are attached to two robotic arms and inserted into the mouth and throat
- The surgeon sits at a nearby console and sees a 3-D, magnified view of the surgical area
- The surgeon controls every movement of the robot, which mimics the movement of the surgeon's hands and wrists
- The surgeon cuts away the tumor and some surrounding tissue with a laser tool
While the surgery is going on, a pathologist is ready and waiting. The surgeon sends the tumor to the pathologist, who examines it under a microscope. Information is then sent back to the surgeon.
Depending on the pathology results, the surgeon may cut away more tissue, remove nearby lymph nodes, or remove other structures in the throat.
When the procedure is complete, the instruments and retractor are removed.
The conventional open procedure for throat cancer is very invasive. Long incisions are made in the chin and throat. Often, the jaw must be split open like a book to gain access to a cancerous tumor.
Patients undergoing open surgery are in the hospital up to 10 days. They typically go from the hospital to a nursing facility where a feeding tube is in place for about two weeks. It takes months before they can speak and swallow. In some patients, a temporary opening in the windpipe, called a tracheostomy, is necessary for breathing.
With TORS, the outcomes are dramatically different. Because there are no incisions:
- There is no disfigurement or scarring
- A tracheostomy is not needed
- Nerves, tissues and muscles in the face and neck are not at risk
Typically, patients undergoing TORS:
- Go home within a day or two after surgery
- Have no need for a feeding tube
- Have significantly less pain after surgery
- Are able to swallow and breathe normally
- Are able to talk normally within a few weeks
Also, the need for follow-up radiation therapy is often eliminated or dramatically reduced after TORS because surgeons are able to remove all or most of the cancer.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
With an open procedure, potential complications include bleeding, post-surgical infection, and the formation of a fistula (tunnel) developing from the mouth to the neck. There is also the risk of damaging nerves in the surgical area.
Complications from TORS are uncommon. Occasionally there is minor bleeding.
TORS surgery for throat cancers is not widely available. Surgeons at Swedish were among the first to offer it in the U.S. There are only a few surgeons in the Northwest that currently perform TORS, and Swedish surgeons have the greatest experience.
In talking with potential surgeons for your procedure, be sure to ask:
- How much TORS experience they have
- How long robotic surgery has been available at the hospital
- How many TORS procedures have been done at the hospital
Swedish is a regional center for performing – and teaching – robotic surgery. More than 4,000 robotic procedures have been performed here and everyone on our robotic surgery teams is specially trained and highly experienced. Our surgeons publish and lecture widely, and train other physicians from around the country.