Transoral Robotic Surgery (TORS)

What is transoral robotic surgery (TORS)?

Transoral robotic surgery (TORS) is a minimally invasive form of surgery that uses robotic technology to treat:

• Throat cancer or benign tumour
• Obstructive sleep apnoea
• Thyroid nodules or cancer

How it works

TORS uses a robot-assisted surgical system, an advanced surgical robot that enables surgeons to access and operate on the throat or tongue base through the mouth.

The procedure does not require any external incisions or sawing of the jaw. It also allows surgeons to operate on the thyroid through small incisions in the mouth without any external incisions.

The robot-assisted surgical system enhances precision through tenfold magnification, removal of tremors and exact translation of the surgeon's movements on the robot.

Why do you need transoral robotic surgery (TORS)?

In traditional open surgery, surgeons need to use highly invasive approaches to access difficult to reach areas, like the back of the tongue or the throat. Examples of these highly invasive approaches include:

• Sawing open the jaw
• Large incisions in the neck, cutting through the swallowing muscles

These approaches may require transplanted tissue flaps from another part of the body, and often result in swallowing impairments. They may also cause external deformities, such as large scars, swelling, sunken areas and deformity at the donor site of the tissue flaps.

In TORS, there is minimal need to cut through normal tissue. There is also no need to transplant tissue from another part of the body. Wounds are able to heal naturally, sensory sensations in the swallowing muscles can be retained, and there is little scarring or disfigurement.

With TORS, general benefits include:

• Better quality of life, as you can eat and drink more normally
• Shorter duration of surgery, shorter hospital stay and faster recovery
• Avoidance of chemotherapy and radiation if the whole cancer is removed completely through surgery alone
• Lower treatment costs

Who should not undergo transoral robotic surgery (TORS)?

TORS may not be suitable for some patients and conditions:

• If the tumour is too large and requires open surgery
• If the tumour has invaded the bones or other structures
• If the patient's anatomy does not allow the proper introduction of the robotic instruments

Our experienced surgeons will discuss your treatment options with you and help you decide on the best course of treatment.

What are the risks and complications of transoral robotic surgery (TORS)?

Regardless of the approach, thyroid surgery carries some risks as with any other surgery.

In transoral robotic thyroidectomy, for example, there are risks of damage to various critical structures surrounding the gland, such as the recurrent laryngeal nerves. These nerves control the movement of the vocal cords. Injury to these areas might cause hoarseness and difficulty in breathing.

Bleeding in the thyroid area may also result in airway compression, which is potentially life-threatening.

How do you prepare for transoral robotic surgery (TORS)?

Your doctor will provide instructions for you to follow before and after surgery. This includes when and what medications to stop taking.

You may need to make arrangements for assistance after the surgery, such as arranging transport home, at-home care and other tasks of daily living. Do check with your doctor what you can or cannot do after surgery (e.g. lifting, walking, driving)

On the day of your surgery:

• Dress comfortably
• Bring the necessary documents (e.g. identification) for your hospital stay.
• Bring a bag of essentials such as personal toiletries and other personal items you may need.

What can you expect in transoral robotic surgery (TORS)?

You will receive general anaesthesia and sleep during the surgery.

Estimated duration

The procedure usually takes about 1.5 – 2 hours.

During the procedure

Your surgeon will use a robot-assisted surgical system to:

• Guide the robotic “arms” into your mouth with the assistance of a high definition, 3D camera. The surgical robot has a mechanical articulating tip that is more flexible than a human wrist, and the 3D visuals provide realistic depth and detail during the procedure. This provides your surgeon with better visualisation, dexterity and precision during the operation.
• Use a laser to resect (remove) the tumour and check all the margins of the tumour to make sure that it has been completely removed.

An assistant will stay by your bedside throughout the procedure to help if needed.

After the procedure

You will be moved to a recovery room after the surgery. Your recovery time will depend on the complexity of your surgery.

Care and recovery after transoral robotic surgery (TORS)

As the procedure is minimally invasive, you can expect to be:

• Home within 1 – 5 days
• Eating and drinking by the first day
• Resuming normal daily activities within a couple of days
• Back to work and exercise within 2 weeks