Many head and neck cancer patients and others requiring surgery for benign lesions of the mouth and throat — including sleep apnea patients — may be candidates for minimally invasive transoral robotic surgery (TORS). Performed through the mouth without the need for skin incisions or extensive dissection, the procedure results in less blood loss than conventional open surgery, a faster healing process, and no visible scars. The swelling that typically accompanies open throat surgery can usually be avoided, and the placement of a temporary tracheostomy can usually be avoided as well. The robotic procedure is also less disruptive to the patient’s ability to speak and swallow.
Surgeons at UCLA are performing TORS for patients with both benign and cancerous lesions of the throat, including the oropharynx, larynx and hypopharynx. For those patients who require it, TORS resection can significantly decrease the overall dose of radiation for head and neck cancer patients, limiting the adverse effects of radiation therapy.
TORS offers advantages over other minimally invasive procedures
Compared with alternative endoscopic approaches — including transoral laser microsurgery (TLM) — that require surgeons to work through a rigid endoscope that limits their vision and range of operation, the state-of-the-art surgical robotic system used at UCLA for TORS offers excellent visualization and dexterity. A highly effective retraction system allows the surgeon to see the entire area of surgery at once, and also to view a magnified, 3-dimensional image. The surgeon controls the position and magnification of the high-definition camera seamlessly during the operation.
Working from the operating console, every movement of the surgeon’s wrists and fingers are translated into movement of the surgical instruments. The surgical tools used with TORS can be rotated and turned with freedom of movement similar to that of a human wrist at the point of surgery. The recent development of 5 mm instruments — thinner than a No. 2 pencil — with improved angulation, or wristing, allows head and neck surgeons greater access to recessed portions of the throat.
TORS at UCLA
UCLA is one of only a handful of medical centers in the western United States performing TORS. The robotic head and neck surgery program consists of specially trained TORS surgeons operating on new-generation robotic systems at Ronald Reagan UCLA Medical Center in Westwood and in our recently opened UCLA Medical Center, Santa Monica.
At UCLA, patients undergo an initial consultation with surgeons performing a thorough evaluation to determine their candidacy for TORS. Patients may need to have an evaluation under general anesthesia to ensure that the TORS retractor fits their anatomy. Some severely obese patients and those with recessed jaws may be among the small percentage of patients who are not good TORS candidates because their anatomy cannot accommodate the retractor.
Depending on the surgery, TORS can take between 30 minutes to a few hours. The head and neck surgery team works closely with speech pathologists to ensure quick recovery of safe swallowing and to allow the patient to return to normal activities as soon as possible.
Achieving the best possible function and quality of life
With the technology, training and expertise to offer transoral robotic surgery (TORS) to qualified patients requiring head and neck surgery, “we are offering these minimally invasive procedures to help our patients get out of the hospital and back to their lives faster and with fewer limitations on their function,” explains Abie Mendelsohn, M.D., assistant professor of head and neck surgery.
Because TORS offers superior dexterity and visualization — providing the ability to see the entire area of surgery at once as well as to view magnified, 3-dimensional perspectives — surgeons are able to minimize the amount of healthy tissue removed. The surgeon works from a console, controlling the high-definition camera and surgical instruments, which respond to every movement of the wrists and fingers.
Among the applications of TORS, UCLA surgeons are treating cancerous lesions, “allowing the radiation oncologist to significantly lower the overall radiation therapy dose so the risk of complications — including swallowing problems and chronic pain — is greatly reduced. The patient can enjoy a better quality of life,” states Dr. Mendelsohn.