Tumors in the throat, base of the tongue and tonsils can be difficult to reach surgically. Traditionally, their surgical removal entailed cutting the jaw, a large incision in the neck, long hospital stays, and extensive swallowing and speech rehabilitation. However, transoral robotic surgery (TORS) allows surgeons to reach these tumors through the mouth, using robotic instruments.

What is transoral robotic surgery? 

TORS is a minimally invasive surgery that uses a robot to access hard-to-reach tumors in the back of the throat or mouth. Using cameras attached to a robotic arm that provide a high-resolution, 3D image, the surgeon guides tools at the end of the robotic arms to remove the tumor. The precision of robotic surgery helps protect surrounding tissue while also safely removing the tumor. This approach minimizes the amount of tissue that is removed during cancer surgery.

Conditions Treated by TORS

TORS is used to treat many conditions, including:

• Oropharyngeal, hypopharyngeal and laryngeal tumors
• Sleep apnea
• Skull-base squamous cell carcinoma
• Benign tumors or cysts in the throat

Who is a candidate for TORS?

Patients with small tumors on the back of the tongue or tonsils are ideal candidates. It is a go-to procedure for patients with HPV-positive tumors that the team identifies as amenable for this surgery. Other factors that determine eligibility include neck disease, mouth opening, overall health and extent of the tumor.

Benefits of Transoral Robotic Surgery

TORS offers many benefits compared with standard surgery, including: 

• Reduced need of chemotherapy or further treatments
• Reduced cost
• Minimally invasive surgery
• Less scarring
• Shorter hospitalization
• Lower risk of infection
• Fewer swallowing side effects
• More precise tumor targeting
• Potential for reduced radiation after surgery

Preparing for Transoral Robotic Surgery

• Preliminary tests such as imaging scans help the surgeon plan the procedure.
• A presurgical swallow evaluation and speech-language pathology consultation will assist with recovery and swallowing function.
• Do not eat or drink anything after 12 a.m. on the day of surgery.
• Tell your health-care provider if you take medications such as blood thinners.
• Follow other instructions provided by the surgeon.

What happens during transoral robotic surgery?

Patients lie on an operating table, with arms from what is known as the “da Vinci” robot (the surgical device named for Leonardo da Vinci that’s used during TORS) above them. Anesthesia is administered, and the surgeon controls the robot to remove the tumor.

How long does transoral robotic surgery take?

Times can vary — it is typically done along with neck surgery to reach the tumors.

Recovery from Transoral Robotic Surgery

Patients will be monitored by the care team for the next few days in the hospital to ensure there are no complications. Pain and difficulty swallowing are common during this time. Much of the initial discomfort is temporary and will improve with time.

Easy-to-swallow and digestible foods are important during the recovery period to prevent complications. Most patients return to their usual activities within two to three weeks. 

Possible Transoral Robotic Surgery Complications

Although complications with TORS are less common compared with standard surgery, no procedure is without risks. Potential complications include:

• Breathing difficulty
• Abnormal bleeding
• Food or liquids entering the lungs
• Temporary swallowing difficulties

When should I contact my health-care provider?

A health-care provider should be contacted immediately if any of these symptoms occur: 

• Fever
• Surgical site bleeding
• Nausea and vomiting
• Dehydration
• Breathing difficulty
• Irregular swelling

Transoral Robotic Surgery (TORS) – FAQs