Transoral Robotic Surgery (TORS)

Tumors in the throat, base of the tongue, and tonsils can be difficult for a surgeon to reach. Removal of these tumors usually requires major surgeries that result in lengthy rehabilitation and often cause difficulty with swallowing and speech.

Advancements in surgical equipment have made it possible to reach these tumors less invasively through the mouth by using sophisticated robotic technology. This approach is called transoral robotic surgery (TORS). The term “robotic” does not mean that robots perform surgery. Your surgeon performs surgery by using instruments of a complex robotic system that he or she guides from a computer console near the operating table.

The robotic system contains two types of arms. The camera arm provides the surgeon with a high-definition, magnified, 3D-enhanced view of the surgical site. The mechanical arms have surgical instruments attached to them. The very thin “wristed” instruments of the mechanical arms move like human hands, but with a greater range of motion. They precisely mimic your surgeon’s arm and hand movements, bending and rotating to extract tumors from surrounding tissue safely. Studies show that TORS preserves swallowing and speech function as well as or better than conventional surgical methods, and with less scarring and fewer complications.

The benefits

Compared with traditional techniques, surgeons who use TORS find that for many procedures it enhances precision, flexibility, visibility and control during the operation. Using TORS, surgeons can perform delicate and complex procedures that may have been difficult or impossible with other methods. In addition to improved cancer outcomes, benefits of TORS include:

  • Fewer complications, such as surgical site infection
  • Shorter hospital stays
  • Less pain and blood loss
  • Faster and easier recovery and return to normal activity
  • Smaller, less noticeable scars

Surgeons in the Head and Neck Cancer Program at Norris Cotton Cancer Center (NCCC), are experienced in the specialty skills required for TORS.

Experts in research

Surgeons in the Head and Neck Cancer Program are also leading even further advancements to today’s surgical approaches. Most notably is the “Virtually Assisted Surgeon” project, led by surgical oncologist Joseph Paydarfar, MD.

Paydarfar’s team is developing image-guided surgical navigation technology that, in the future, could help reduce complications and improve tumor removal in throat cancer surgery.

Utilizing Dartmouth-Hitchcock’s state-of-the-art Center for Surgical Innovation, which houses both intraoperative CT and MRI scanners, the team is working to develop a laryngoscopy system that is CT- and MRI-compatible. This technology would give surgeons more image guidance during surgery. They could more accurately locate critical structures such as arteries, and more effectively remove tumors completely. The results? Safer surgeries and better outcomes.

As part of a major academic medical center, NCCC also participates in investigator-initiated and national clinical trials. Trials may include, for example, promising medications or chemotherapy drugs, new devices, or advancements in robotic surgery technology. View the list of head and neck clinical trials with which this cancer care program is currently involved.

Is TORS right for you?

Approximately 20 to 30 percent of patients with throat tumors may be eligible for TORS. Each new patient’s case is discussed at a weekly meeting of experts from across the Dartmouth-Hitchcock Health system. In these meetings, the team decides on the best treatment plan to recommend to each individual patient based on their own unique circumstances. If you are a candidate for transoral robotic surgery, your provider will discuss this option with you.

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