Trans-Oral Robotic Surgery (TORS)

Trans-oral robotic surgery (TORS) is an advanced minimally invasive alternative to open surgery, or transoral laser surgery, for the treatment of some head and neck pathologies like tumours of the oropharynx, hypopharynx and larynx; and particularly oropharyngeal carcinoma, which is rapidly increasing in incidence. TORS may also be used to treat obstructive sleep apnoea (OSA).

It is a complex procedure which an experienced surgeon performs through the mouth of the patient using robotic arms. It is performed under general anaesthesia and has been shown to be cost-effective, with significantly shorter hospital stays and fewer treatment-related costs.

Rise of Oropharyngeal Cancer

The incidence of oropharyngeal cancer (OPC) is increasing alongside rising rates of human papillomavirus (HPV) infection. This surge in population-level incidence, amounting to a 225% rise, is being recognised as an 'epidemic' globally. Australian data shows a notable shift in HPV-associated OPC cases, rising from 20% in 1987 to 64% in 2010. Typically, HPV-associated OPC affects middle-aged, affluent males, contrasting with conventional oral cavity squamous cell carcinoma (SCC) which is more prevalent among elderly people from comparatively lower socioeconomic status, often with histories of smoking and alcohol use.

Traditionally, the primary treatment for oropharyngeal SCC involved chemoradiotherapy (CRT) or radical surgery with mandibulotomy and neck dissection for advanced disease salvage. CRT, while allowing organ preservation, necessitates daily treatments over six to seven weeks and is linked with various morbidities including mucositis, , taste loss, speech and swallowing impairments, dental issues, and osteoradionecrosis. Similarly, open surgery carries xerostomia, significant morbidity and requires prolonged hospitalisation.

The advent of Transoral Robotic Surgery (TORS) has started to revolutionise OPC management.