Imagine that you’ve been told you have a tumor located deep in your throat, and that it can only be treated with highly invasive surgery or, worse yet, that it’s inoperable. That awful scenario was the reality until recently, but a technique called Transoral Robotic Surgery (TORS) is changing that.
In December, 2009 the FDA approved the da Vinci robotic surgery system for removal of certain head and neck tumors, including those of the mouth and throat. Dr. Jeffrey Livingston is a board certified otolaryngologist (more commonly known as an ear, nose and throat doctor or ENT) at Vero ENT Associates; he says, “TORS is a complicated technology. Doctors need to receive special training to perform it; it is most commonly done at teaching centers, like the University of Miami.”
TORS is performed through the patient’s open mouth; an endoscope (flexible tube with a lighted camera) provides a 3-D, high resolution image of the back of the mouth and throat. The surgeon, who is sitting at the head of the patient, operates the system’s “arms” – wristed instruments that can bend and rotate with much greater dexterity than the human wrist. The surgeon guides a laser to remove the tumor, checking its margins to ensure it was completely removed.
Compared to more invasive surgery, benefits of TORS for tumors of the mouth and throat include:
• The TORS procedure typically takes less than two hours, rather than 10 or more hours.
• The length of the hospital stay is reduced from a week, or even two, to about 2 days.
• No external incision means no visible scarring. More invasive surgery requires an incision from the lip to the throat, and the cutting of the jaw.
• Quicker return to speaking and swallowing; sometimes as early as the day after the procedure.
• Overall speedier recovery.
• Less cost; this ultimately results in savings for the patient.
Chemotherapy or radiation may still be needed after TORS; that determination is almost always made based on whether or not there is cancer in the lymph nodes. Even if post-operative treatment is needed, it can often be more targeted and at a lower dose, which is a huge patient benefit.
Robotic surgery itself predates TORS. Da Vinci, the first robotic system, was approved by the FDA in 2000 for certain procedures, including general laparoscopic and urological surgeries. We have written before about da Vinci and minimally invasive robotic surgery; specifically its use in the treatment of lung cancer.
Dr. Livingston says robotic surgery is still more common in general procedures than those conducted by an ENT; he has not performed TORS, nor does he believe any physician in Indian River County has, as of yet. Speaking of tongue cancers specifically, he says “They are rare and many are treated non-surgically.” He does say that the da Vinci robot for TORS has distinct advantages if a surgical option is chosen by doctor and patient.
TORS is also a possible option for patients with obstructive sleep apnea (OSA), a disorder in which breathing repeatedly stops and starts during sleep. Some patients with OSA have excessive tissue at the back of the tongue that causes airway obstruction; TORS can be used to remove that tissue. Promising results were reported in the July 2013 issue of The Laryngoscope, by Ho-Sheng Lin, M.D., a fellow with the American College of Surgeons, although the sample size was too small to draw any definite conclusions.
A CPAP machine (continuous positive airway pressure) is usually the first treatment tried for OSA, but some sufferers find the mask that needs to be worn uncomfortable, and become non-compliant with the treatment. If TORS is performed, the CPAP may still be necessary, but there are indications that it is better tolerated after the procedure.
Referring to TORS and obstructive sleep apnea, Dr. Lin said in the July 2013 report, “The procedure we have focused on is not a cure-all, and its use is still in its infancy. But surgeons now have a new, safe and precise technique to add to their treatment options.”
Vero ENT Associates is located at 1235 36th Street, Suite A, in Vero Beach; the office phone is 772-563-0015.
