Transoral Robotic Surgery (TORS) for Head and Neck Cancer

At Saint John’s Health Center, we employ a multi-disciplinary, minimally invasive approach to oncologic conditions including cancers and tumors of the head and neck.

We are committed to providing compassionate and comprehensive care for our patients. Our surgical teams are dedicated to ensuring the best possible outcomes through advanced surgical techniques like Transoral Robotic Surgery (TORS), combined with personalized support and attention to each patient’s unique needs.

What is Transoral Robotic Surgery?

Transoral Robotic Surgery (TORS) is a minimally invasive procedure that uses advanced robotic technology to access and remove hard-to-reach tumors in the back of the throat or mouth. Offered at Saint John’s Health Center in Santa Monica, CA, this innovative approach uses cameras attached to a robotic arm, providing a high-resolution, 3D image that allows the surgeon to guide tools with precision.

By using TORS, surgeons can protect surrounding tissues while safely removing the tumor, minimizing the amount of tissue removed during cancer surgery. The procedure is performed under anesthesia, with the surgeon controlling the robot from inside the surgery room to ensure accurate tumor removal.

How does TORS treatment improve care compared to traditional surgery?

Tumors located in the throat, base of the tongue, and tonsils can be particularly challenging to reach surgically from outside the body. TORS offers a solution by allowing surgeons to efficiently access these tumors through the mouth, using small robotic instruments, all without the need for external incisions. This technique not only improves surgical outcomes because of the dexterity of the robot but also reduces the likelihood of complications compared to standard surgery.

When is TORS recommended?

TORS is commonly used for patients with small tumors on the back of the tongue or tonsils, especially those who are Human Papillomavirus (HPV)-positive. HPV is a significant factor in oropharyngeal cancers, with approximately 70% of these cancers linked to the virus. While oral HPV infection is common, the risk of developing oropharyngeal cancer remains relatively low, where men are three times more affected than women, and is more common with older age. The prevalence of oral HPV in the general US population is estimated to be around 7%. TORS is also effective for treating hypopharyngeal and laryngeal tumors, as well as sleep apnea, skull-base squamous cell carcinoma, and benign tumors or cysts in the throat. Ideal candidates for TORS are those with small, accessible tumors in these areas.

The benefits of TORS are numerous. Patients often experience a reduced need for chemotherapy or additional treatments, leading to improved patient outlook and lower overall costs. The minimally invasive nature of the surgery results in less scarring, shorter hospital stays, and a lower risk of infection. Additionally, TORS offers more precise tumor targeting, fewer swallowing side effects, and the potential for reduced radiation therapy after surgery.

Dr. Vivian Wu explains the benefits of TORS

Preparing for Transoral Surgery?

Preparing for TORS involves several preliminary steps. Imaging scans help the surgeon plan the procedure to better understand the extent of the tumor’s growth, while a presurgical swallow evaluation and consultation with a speech-language pathologist can assist with recovery and swallowing function. Patients are advised not to eat or drink anything after midnight on the day of surgery and to inform their healthcare provider if they are taking medications such as blood thinners. Following the surgeon’s instructions is crucial for a successful outcome.

Recovery from TORS typically involves a few days of hospital monitoring to ensure there are no complications. Pain and difficulty swallowing can be common during this period, but these symptoms are usually temporary and improve with time. Patients are encouraged to consume easy-to-swallow and digestible foods to prevent complications and support healing. Most individuals can return to their usual activities within two to three weeks.

Side effects or challenges of TORS?

While complications with TORS are less common than with standard surgery, it is important to be aware of potential risks. These may include breathing difficulties, abnormal bleeding, food or liquids entering the lungs, and temporary swallowing difficulties. Patients should be vigilant and contact their healthcare provider immediately if they experience symptoms such as fever, surgical site bleeding, nausea and vomiting, dehydration, breathing difficulty, or irregular swelling.