Transoral Robotic Surgery (TORS)

Transoral robotic surgery (TORS) is a minimally invasive surgical procedure that utilizes a robotic system to remove tumors or other lesions from the mouth and throat. This approach allows for precise dissection and removal of tissue through the mouth, without the need for external incisions.

Indications

TORS is commonly used to treat various conditions, including:

• Oral cancer (e.g., tongue, tonsil, and floor of mouth cancers)
• Oropharyngeal cancer (e.g., tonsil and base of tongue cancers)
• Hypopharyngeal cancer
• Benign tumors (e.g., papillomas and cysts)
• Obstructive sleep apnea (OSA) due to tumor or tissue obstruction

Procedure

The TORS procedure typically involves the following steps:

1. Patient preparation: The patient is positioned on the operating table and administered general anesthesia.
2. Robotic system setup: The robotic system, consisting of a console, arms, and instruments, is set up and calibrated.
3. Mouth opening: The patient's mouth is opened using a specialized retractor to provide access to the surgical site.
4. Tumor identification: The surgeon uses the robotic system's high-definition camera and instruments to locate and visualize the tumor or lesion.
5. Tumor removal: The surgeon uses the robotic instruments to dissect and remove the tumor or lesion, often in a piecemeal fashion.
6. Hemostasis: The surgeon achieves hemostasis using electrocautery or other methods to control bleeding.

Benefits

TORS offers several benefits over traditional open surgery, including:

• Reduced risk of complications (e.g., infection, bleeding, and nerve damage)
• Less postoperative pain and discomfort
• Faster recovery times and shorter hospital stays
• Improved functional outcomes (e.g., speech, swallowing, and breathing)
• Enhanced cosmetic results due to the lack of external incisions

Robotic System

The robotic system used in TORS typically consists of:

• A console: The surgeon sits at a console with a high-definition display and controls the robotic arms and instruments.
• Robotic arms: The robotic arms are equipped with specialized instruments (e.g., scissors, graspers, and electrocautery) that are used to perform the surgery.
• Instruments: The instruments are designed for precise dissection and removal of tissue, with features such as articulation, rotation, and tremor filtration.

Training and Certification

Surgeons who perform TORS typically undergo specialized training and certification programs, which include:

• Didactic education: Surgeons learn about the principles and techniques of TORS through lectures and online modules.
• Cadaveric training: Surgeons practice TORS procedures on cadavers to develop their skills and familiarity with the robotic system.
• Mentorship: Experienced surgeons mentor less experienced surgeons during live cases to ensure proficiency and safety.