Let's learn about transoral robotic surgery (TORS) in a simple way!

Everyone gets a little scared when they hear about having surgery on places like the throat, back of the mouth, or the base of the tongue, right? But now technology has advanced a lot. There is a way to do this kind of surgery inside the mouth, without making large incisions in the neck and jaw like before. This latest method, which is done with the help of a robot, is called TORS, which stands for Transoral Robotic Surgery. Today, we will talk about this in simple terms.

Simply put, what is TORS?

TORS is a procedure in which a surgeon uses a computer system to control robotic arms. Imagine that a tiny camera and surgical instruments are inserted through your mouth and down your throat. The doctor controls the robotic arms from a computer console while viewing the clear 3D view from the camera.

These robotic arms are like an extension of a doctor's hands. But they are designed to be more delicate, stable, and flexible than a human hand. This allows them to remove cancerous tumors deep inside the mouth, such as those in the throat and the base of the tongue, which are normally difficult to reach, without making any incisions on the outside. The most commonly used technology for this is the ``da Vinci® Surgical System``.

What conditions are treated with TORS surgery?

Although TORS surgery is primarily used for head and neck cancers, it is now widely used for non-cancerous conditions as well.

Who is suitable for this surgery?

TORS surgery is not for everyone. Your doctor will decide if you are a good candidate for it. They will consider many factors, including your overall health, the structure of your head and neck, and the extent of the cancer .

This surgery is generally not recommended for people with the following conditions:

• If the cancer has spread to the point where it cannot be removed with surgery.
• If anesthesia is risky due to breathing difficulties.
• If it is difficult to insert the instruments due to the mouth being too small or for some other reason.
• If there is a risk of excessive bleeding during surgery.

The doctor who examines you will only recommend TORS if he or she is confident that it is the safest and most effective treatment for you, after considering all of this.

How the surgery is performed and recovery time

Preparation before surgery

Your doctor will order tests such as scans to plan your surgery. You may also need to see a speech-language pathologist to help you manage swallowing difficulties after surgery. Your doctor will also give you instructions on not eating or drinking after midnight the night before surgery and stopping certain medications, such as blood thinners .

What happens during the surgery?

The surgery is performed while you are fully anesthetized (put to sleep). So you won't feel any pain. The doctor will insert a robotic camera and instruments into your mouth and watch on a computer screen to completely remove the cancer. Sometimes, a small incision may be made in the neck to see if the cancer has spread to the lymph nodes in the neck and a ``neck dissection'' may be done to remove some lymph nodes .

The surgery itself takes about 1.5 - 2 hours, and the entire process can take about 4-5 hours.

How long does it take to heal?

This is one of the biggest advantages of TORS. You can usually go home after 2-3 days in the hospital. You can resume your normal activities within a few weeks.

• There may be a sore throat and difficulty swallowing for about 2-3 weeks after surgery.
• During this time, you may need to be given the nutrition you need, and you may need to have a temporary feeding tube inserted through your nose.
• Recovery is different for everyone, so it's important to listen to your body and take your time to heal.

What are the main advantages of TORS surgery?

There are many advantages to TORS compared to traditional open surgery.

• High precision: Because the robotic arm is so delicate, it can remove only cancer cells with great precision, minimizing damage to surrounding healthy tissue.
• Quicker recovery and shorter hospital stay: Whereas you used to have to stay in the hospital for 1-2 weeks, now you can go home in 2-3 days.
• No visible scars: Since the surgery is performed entirely inside the mouth, there are no major scars on the neck or face.
• Reduced side effects: The risk of excessive bleeding, long-term problems with speaking and swallowing is very low.
• Reduced need for additional treatments: This may reduce or even completely eliminate the amount of radiation or chemotherapy needed after surgery.

Risks and when to see a doctor

As with any surgery, TORS carries some risks. However, these are much lower than open surgery. There are some risks, such as excessive bleeding (hemorrhage), aspiration of food or fluids into the lungs, and difficulty breathing. These risks are further reduced by an experienced surgeon.

If you experience any of the following symptoms after your surgery, notify your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

• Signs of infection such as fever.
• Signs of dehydration such as dry mouth and dark urine.
• Bleeding from the surgical site.
• Severe difficulty breathing or swallowing.
• Nausea and vomiting.
• Abnormal swelling.

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