Transoral robotic surgery

The human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. While often associated with cervical cancer, HPV can also cause cancer to develop in the head and neck, typically transmitted through oral sex. Oropharyngeal cancer, a head and neck cancer that develops in the throat and includes the back of the tongue, the soft palate, tonsils and inner walls of the throat, is often caused by HPV infections. In fact, 70% of oropharyngeal cancers are associated with HPV infections.

Transoral robotic surgery (TORS) is a minimally invasive, robotic surgery that replaces the need to perform a mandibulotomy, a procedure that requires a surgeon to cut through and reconstruct the jaw to reach cancer in the back of the throat. 

By performing TORS using the da vinci® SP System, your surgeon can remove a tumor by navigating the robotic system through your mouth and down the back of the throat, without having to make an incision. 

TORS is a safe and innovative surgical option and was approved by the U.S. Food and Drug Administration (FDA) in 2009.

Additional benefits of TORS include:

• Quicker recovery time 
• Reduced impact on quality of life (less long-term swallowing, eating or speaking problems)
• Typically shorter hospitalization following the procedure (the average hospital stay is about 2 days, compared to one to two weeks required for more invasive procedures)
• Less risk of infection and need for blood transfusions
• Decreased likelihood of needing a tracheostomy (a hole made in the front of the neck and windpipe to aid with breathing during, and sometimes after, surgery)

Your head and neck surgeon, also known as an otolaryngologist, determines your treatment plan and performs your surgery to remove the cancer. They may also perform procedures to help diagnose cancer, such as a biopsy. 

At GenesisCare and affiliated practices, our otolaryngologists are board certified, which means that they have been specially trained in surgical cancer care according to defined national criteria for certification and they continuously maintain the highest quality standards through participation in continuing medical education. This provides them with training on the latest treatment techniques and advances. Some have also completed extra training called a fellowship, which is additional specialized training in the surgical management of head and neck cancer patients.

During TORS, your surgeon will place a thin robotic instrument and camera down your throat. He/she will sit at a control panel nearby that shows a 3D and high-resolution image from the camera. Your surgeon will also control the robotic instruments from this same panel to remove the tumor. These instruments are incredibly flexible and precise, mimicking the movement of your surgeon’s hands. 

Your care team will advise you on the appropriate after care instructions after surgery. Typically, you will remain in the hospital for a day or two while you recover. During this time, you will have a swallow evaluation to make sure there are no concerns with your throat. You may have a feeding tube placed in your nose to provide nutrition while you recover. After a few days, you should be able to begin a clear liquid diet, advancing later into a soft diet.

Typically, your surgeon will want to meet with you within one to two weeks after surgery to make sure you are healing well, discuss any new post-operative instructions and remove your drain if you have one. 

Following your post-operative appointment, your surgeon will help coordinate with other physicians who specialize in medical oncology and radiation oncology to obtain an opinion about those options and determine if additional therapy is needed for your individual situation. 

In general, our head and neck surgeons will follow you for five years or more after your surgery, even if you continue treatment with other specialties, to help address any concerns and watch for any signs of recurrence.

Coverage varies by insurance carrier and plan. Contact your insurance carrier to see if they provide coverage for transoral robotic surgery.