Transoral robotic surgery

Transoral Robotic surgery is a procedure in which surgical robots as an assistant to remove the mouth and throat cancers or to remove the tumor from the mouth and the throat. This surgery gives the surgeons an enhanced view of the affected part and the surrounding tissues. In TORS, the arms of the robots are strategically placed inside the mouth or throat which allows the movements in tiny places in tiny spaces in a more precise and also gives the capability to the surgeons to work around corners by controlling the arms of the robots while sitting in his console. As compared to the traditional procedures, the TORS tends to result in a quicker recovery and fewer complications in mouth and throat surgeries.

Current Robotic System

The Da Vinci Surgical System comprises of three components: a surgeon’s support, a patient-side robotic cart equipped with four arms, and a high-definition three-dimensional vision cart with a centrally located endoscope. Articulating surgical instruments are mounted on the robotic arms, which are presented into the upper aerodigestive tract through the mouth of the patient and controlled remotely with master robot controllers from the surgeon’s support.

The working ends of the two instrument arms are equipped with greatly small (5-mm and 8-mm) mechanical “endowrists,” which have a 360° extent of movement and which are controlled with handles at the surgeon’s support. The system incorporates hand tremor filtration and movement scaling that translates the large developments of the surgeon’s hands to the little movements of the mechanical instruments. The dexterity and precision managed by the more agile developments of the small mechanical instruments permit more exact dealing with of tissues, improved definition of safe surgical margins, and the capacity to adjust surgical procedures to intraoperative discoveries.

Risks

As with any the procedure, there are risks that you need to be aware of. The level of  risk will vary depending on the extent and type of surgery you undergo:

1.    Bleeding, including hematoma: If there is severe bleeding after the procedure, your surgeon might need to quickly take you back to the operating room to stop the bleeding.

2.    Infection: The tongue and the pharynx have a strong blood supply, and as such, infections of the tongue are extremely uncommon. Still, as with any surgical procedure, there is always the risk of an infection after the surgery, particularly if the glossectomy is associated with additional procedures that might connect the mouth with the neck. This might require antibiotics and/or drainage of the infection.

3.    Dysarthria, or difficulty speaking: The extent your speech is affected will depend on how much and what part of the tongue is removed. You may consult with a speech and swallowing specialist to improve your function.

4.   Dysphagia, or difficulty swallowing: The extent that your swallowing is affected will depend on how much and what part of the tongue or pharynx is removed.

5.    Salivary fistula: This means that saliva is leaking from the mouth into the neck. Avoidance of this problem is why some surgeons choose to delay the neck dissection for a few weeks after the TORS procedure. The chances of this increase, if you have had previous treatment including radiation and/or chemotherapy. This is because wound healing might be impaired in these cases.

Typical treatment for usually to place a drain to divert the saliva away from critical structures within the neck and afterward to put packing into that diverted tract and let the body heal it up on its own. In a few cases, an extra surgical method can be required to close the leak.