Trans-Oral Robotic Surgery (TORS)
TORS System & Procedure
TORS uses a robotic surgical system such as the FDA-approved da Vinci® Surgical System (clicking it opens, on different tab, da vinci technology website) which includes robotic arms that are equipped with miniature surgical instruments and a camera that provides a high-definition (HD), 3D-magnified view of the surgical site.
The robotic system consists of three parts (Figure 1):
a console with which the surgeon (seated) remotely controls the robotic arms
a patient-side robotic cart with three robotic arms positioned inside the oral cavity – one handling the 12 mm endoscopic camera and two holding 5 mm EndoWrist instruments
a high-definition, three-dimensional vision cart.
Figure 1. Illustration of surgical system robot
A - surgeon’s console; B - patient-side robotic cart; C - high-definition, 3D vision cart
Reproduced from Garg A, Dwivedi RC, Sayed S, et al. Robotic surgery in head and neck cancer: A review. Oral Oncol 2010;46(8):571–76, with permission from Elsevier
The surgeon, assisted by a surgical team, operates the mechanical arms from a console located near the operating table. Its HD camera provides heightened visualisation, magnified detail, true depth of field and a comprehensive view. Once the patient is under general anaesthesia, the robotic arms are inserted through the mouth (transoral) of the patient to reach the targeted area, thereby avoiding the need for external incisions.
The movements of the surgeon's hands are then translated into precise movements of the robotic instruments inside the patient's body, enhancing a head and neck surgeon’s skills. The surgical console’s exceptional ergonomics boosts human capabilities through wristed instruments that can bend and rotate over a wider range than the human hand, to remove tumors, perform tissue biopsies, or reconstruct affected areas. Overall, the TORS approach results in precision and control when operating in the upper airway, hence minimising trauma to surrounding tissues and reducing recovery time after surgery.
Dr Naveed Basheeth (Intuitive Certified) performs TORS
Dr Naveed Basheeth performs Transoral Robotic Surgery at Southern Cross North Harbour Hospital, Auckland, for patients diagnosed with benign throat tumours and early-stage throat cancer. Dr Basheeth completed his training in TORS in QE2, NSHA, Dalhousie University, Halifax, Canada, and is one of the very few Robotic Head & Neck Surgeons in New Zealand, Certified by Intuitive to perform TORS.
He works with his TORS team to achieve the most satisfactory outcome for patients. Being minimally invasive, patients are encouraged inherently, to consider this emergent state-of-the-art robotics for cancer, sleep apnoea and other throat related conditions.
