Head and neck robotic surgery
A long time excpected revolution
The advances in minimally invasive surgery at the level of the upper airway are spectacular. Traditionally, to access a tumor located in the larynx, it is necessary to make an incision in the neck, often perform a mandibulotomy, that is, break the jaw and finally leave a tracheostomy, a tube in the trachea to breathe, during minus 10 days. But not anymore with robotic surgery.
Thanks to da Vinci robotic surgery, these invasive procedures are no longer necessary since they are performed without any incision through the mouth, which is called TORS (Trans Oral Robotic Surgery).
What is TORS robotic surgery?
Transoral robotic surgery (TORS) is a minimally invasive intervention that uses a combination of high-definition 3-dimensional images, da Vinci robotic technology, and small surgical instruments, which allows the surgeons removing a benign or malignant tumor from the throat (larynx, pharynx or tongue base) without incisions.
On the other hand, in open surgery, an extensive incision that goes from ear to lip to access the tumor is required for throat cancer, a tracheostomy (orifice in the trachea to breathe) is performed, which is maintained several days after surgery and in some cases, it also requires breaking the jaw.
TORS surgery does not require an external incision since the thin robotic arms and small surgical tools used in trans-oral robotic surgery are guided by the surgeon to the tumor site through the mouth. The immersive 3D camera provides the surgeon with enhanced details, real depth of field and a panoramic view, while the robotic wrist allows a greater range of motion than those of the human hand. This improved visualization, precision, and dexterity provide significant advantages when working in difficult to reach and delicate areas such as the throat, thus avoiding possible injuries to neighboring structures.
The advantages of TORS surgery are reinforced by the unique ergonomics of the surgical console that helps relieve fatigue and the mechanics of the surgeon, allowing stable movements without trembling.
TORS advantages
Thanks to the minimally invasive TORS approach with the da Vinci robot, significant benefits are achieved, including:
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Less blood loss
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Less post-surgical pain and less medication
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Faster recovery and return to normal activities
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Faster return to normal speech and swallowing
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Shorter hospital stay: 2-3 day stay versus 10-21 day stay with conventional open surgery
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No visible scars, no external incision
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Less risk of complications
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Reduced need for chemotherapy or radiotherapy
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A tracheostomy usually is not required
Is TORS right for me?
Probably yes. TORS has two main applications: the treatment of tumors of the upper airway (larynx, pharynx and tongue base) and obstructive sleep apnea syndrome (OSAS). TORS allows the surgeon to work safely, in a very small space, such as the oropharynx, with an amplified three-dimensional vision and without tremor.
TORS oncology surgery
Síndrome de apnea obstructiva del sueño (SAOS)
Surgical approaches through the neck, with or without opening of the jaw (mandibulotomy), are traditionally used to remove tumors of the upper airway, such as larynx tumors, pharyngeal tumors or tongue-based tumors. However, these approaches produce changes in phonation, swallowing and breathing, and significantly increase the time of hospitalization and rehabilitation. Currently, with TORS, the removal of these tumors is achieved without the need to perform these invasive maneuvers, avoiding cosmetic and functional sequelae, thus obtaining a superior and much faster recovery.
Patients suffering from OSAS are usually managed with equipment that produces continuous positive airway pressure (CPAP). The use of these devices usually deteriorates the quality of life of patients and does not gives a definitive solution to the problem, which is usually related to obstruction of the pharynx due to the collapse of the pharyngeal walls or hypertrophy of the tonsil tissue in the base of the tongue. TORS allows a minimally invasive approach in these cases, achieving a significant decrease in the apnea index, a significant increase in oxygen saturation and an improvement in sleep quality.
Meet your surgeon
Dr. David Virós Porcuna
Dr. Virós is a renowned otolaryngologist, specialist in head and neck oncology surgery, head and neck and facial reconstructive surgery, salivary and thyroid gland surgery.
He presented his Doctoral Thesis in 2010 at the Autonomous University of Barcelona obtaining the "Cum Laude" qualification and is a researcher in different projects related to head and neck cancer.
He is the author of numerous international scientific publications and a reference in minimally invasive and robotic surgery.