Trans-Oral Robotic Surgery (TORS)
Indications & Candidature for TORS
Candidates for TORS are typically those with conditions of the head and neck, that are suitable for transoral (through the mouth) access. Factors such as tumour size, location, and patient health are considered in determining eligibility.
TORS is primarily used for removing small to moderate-sized (up to 4 cm) oropharyngeal cancers, such as those found in the tonsils, base of tongue, and soft palate. It is also employed for excising other types of benign and malignant growths in the oropharynx, hypopharynx, and larynx (voice box). Obstructive sleep apnoea caused by enlarged tonsils or base of tongue, can also be treated. This robotic treatment is also suitable for people with unknown/undiscovered primary squamous cell carcinoma SCC a.k.a carcinoma unknown primary (CUP) , during which the pathologist usually finds the source of the primary tumour.
Additionally, TORS has been successfully utilised for procedures like skull base surgery, partial supraglottic laryngectomy, total laryngectomy, treatment of parapharyngeal tumours, closure of paediatric laryngeal clefts, and various reconstructive surgeries.
Typically, tumours located in the oral cavity in front of the junction of the hard and soft palate are not treated using TORS, except for those situated in the posterior tongue, where access remains challenging through conventional means.
TORS is highly recommended in such incidences since the mechanical hands allow a broad range of movement along with enhanced imaging, precision, and dexterity, thereby offering significant benefits when working on hard-to-target and delicate areas of the throat, and avoiding potential injury.
Comparison to Conventional Treatment Options
Accessing the oropharynx poses challenges, often requiring complex surgical methods like mandibulotomy, that last long hours, involve extensive dissection and often necessitates further procedures. Transoral laser surgery offers a less invasive option but has limited visibility and technical difficulty due to the use of long manipulators.
TORS has currently become the leading minimally invasive technique by utilising a transoral approach that eliminates the need for external incisions, thereby avoiding facial scarring. Comparatively, this procedure offers superior cosmetic results, fewer complications, less postoperative discomfort, and reduced hospital stays combined with better results with restored speech and swallowing abilities.
For about a third of patients, TORS can effectively serve as a standalone treatment, sparing them the side effects of chemoradiotherapy and reducing the need for multiple outpatient visits. While the majority of patients may still require adjuvant radiotherapy or chemotherapy after TORS, these treatments can be administered with potentially reduced doses and treatment durations, resulting in fewer side effects.
Generally, for cancer, surgery is recommended as initial cure. But those who wish to undergo chemotherapy or radiation therapy as the primary treatment (before undergoing surgery) can also opt for TORS later. However, performing a salvage surgery (surgery as the secondary option after chemotherapy or radiation therapy) will subject the patient to unpredictable postoperative scenarios along the lines of survival, healing and good swallowing functions.
