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School of Medicine
Transoral Robotic Surgery (TORS)
Tumors in the throat, base of the tongue, and tonsils can be a technical challenge to reach and have traditionally been removed through surgeries requiring a large neck incision and cutting of the bottom jaw. These types of surgeries often require long hospital stays, extensive rehabilitation and may result in difficulty in swallowing and speaking.
Advances in surgical equipment have made it possible to reach these tumors through the mouth by using robotic technology and minimally invasive techniques. The surgical approach allows for a guided endoscope to provide a high resolution, 3D image of the back of the mouth and throat that is a difficult area to reach with conventional tools. With two robotically-guided instruments that act as a surgeon’s arms, tumors are able to be dissected free from surrounding tissue safely.
For more information, contact head and neck cancer surgeon Wayne Koch, M.D., at 410-997-6467.
Patients who may benefit most from robotic procedures include those with early stage tumors with limited lymph node involvement in the neck. Approximately 20 to 30 percent of patients with oropharygeal (tonsils and tongue base) tumors may be considered ideal candidates for the procedure. Patients with certain tumors of the larynx and throat may also be candidates. Patients who smoke tobacco or have Human Papillomavirus (HPV) negative tumors are especially encouraged to receive surgical treatment for their cancer as these cancers often do not respond as well to radiation and chemotherapy.
What are the Benefits?
Studies show that the outcomes of transoral robotic surgery (TORS) result in swallowing and speech function that is as good or better than other surgical methods, but without invasive scars. Other benefits when treating oropharynx cancers with TORS include:
- For some early stage cancers, the final pathology evaluation may demonstrate that there is no need for extra treatments since the TORS provides a high chance of treating the cancer alone.
- For other cancer stages, extra treatment may only involve radiation therapy and may not need the addition of chemotherapy with the radiotherapy. Even when radiation therapy is recommended, there are several additional advantages that may be helpful in the right case to reduce the risk of swallowing injury from the treatment.
- The doses of radiation that are currently recommended are lower than if the cancer was treated non-surgically and may be able to offer a lower risk of injuring the swallow muscles and nerves of the throat.
- In some cancers, the surgical removal of the cancer can also help to reduce the volume of the throat that is often unnecessarily irradiated and decrease the risk of injury to the swallowing muscles and nerves.
Pairing Surgery with Radiation
Most patients undergoing TORS for oropharyngeal cancer still need to receive radiation therapy. At Johns Hopkins Hospital, Dr. Harry Quon specializes in radiation oncology of the head and neck and has extensive experience with the delivery of radiation therapy after TORS. He is also leading research into different strategies that are de-intensifying therapy in oropharynx cancers that are associated with the human papillomavirus (HPV).
Why Choose Johns Hopkins
The multidisciplinary head and neck cancer team at Johns Hopkins is committed to providing the highest quality care possible for our patients. This involves close collaboration of many world-class experts—in including surgeons, radiation oncologists, surgical oncologists, medical oncologists, dentists, speech-language pathologists, nurses, physical therapists, and counselors and cancer coordinators. Every new case is presented to our weekly Tumor Conference to discuss and determine the best treatment plan for the patient. While not all patients may be candidates for TORS, they will be presented with all treatment plans that the Tumor Board and his/her physicians feel are most appropriate for further discussion.
Johns Hopkins is a major research center with many active clinical trials for patients with head and neck cancer. These trials involve cutting-edge research aimed at improving the treatment methods that we currently have available to our patients. Johns Hopkins surgeons are monitoring patients who receive TORS for oropharyngeal cancer with pre- and post-operative tests on swallowing, speech and quality of life. The results may help surgeons compare the outcomes of robotic procedures with more conventional ones.
Surgeons at Johns Hopkins are working with computer and bioengineering experts at the Johns Hopkins University to develop a robotic tool to improve surgeons’ access to the larynx (voice box). Head and neck cancer physicians generally use a flexible scope called a laryngoscope to access the voice box and other areas of the throat. Johns Hopkins experts are developing a robotic laryngoscope that can be used by thumbing a joystick with one hand. By threading a laser fiber optic line through the device, surgeons can remove tumors without using a scalpel in otherwise unreachable areas. They believe that such a device can also provide improved high resolution images of the throat, dexterity around corners, and required stability to use in operating room settings.
Scarless Surgery for Thyroid Tumors
To avoid invasive scarring on the neck from thyroid surgery, patients are turning to Johns Hopkins surgeons who are using a new technique to remove the endocrine gland.
Young, healthy patients with select benign or suspicious lesions in the thyroid could be considered candidates for a robotic surgical procedure called the Robotic Facelift-Approach Thyroidectomy that involves accessing the thyroid gland through a remote incision that is not visible to the casual observer. A facelift-type incision is made behind the ear that avoids a visible scar on the neck. Patients that are highly motivated to avoid a visible neck scar are encouraged to discuss this option with their physician.
Post-operative appearance 1 month after surgery
Johns Hopkins surgeons will be monitoring outcomes of patients treated with the procedure. They are also studying the feasibility of removing the thyroid gland through the bottom of the mouth with robotic devices.