Transoral robotic surgery

TransOral Robotic Surgery (TORS) is a modern surgical technique used to treat tumors of the mouth and throat via direct access through the mouth. TransOral Robotic Sleep Apnea (TORSA) surgery utilizes the same approach to open the upper airway of patients with obstructive sleep apnea. In TORS and TORSA procedures, the surgeon uses a surgical robot to view and access structures in the oral cavity (mouth) and pharynx (back of the throat) without the previous external incisions through the neck, chin or lip. Current TORS techniques include radical tonsillectomy, resection of palate and base of skull tumors, hemiglossectomy and resection of tumors above and involving the larynx. The TORSA technique is used for uvulopalatopharyngoplasty, hemiglossectomy, and other airway procedures.

The TORS technique was first developed in 2004-2005 by Drs. Gregory Weinstein and Bert O'Malley Jr. at the University of Pennsylvania. At the time, surgical robots, in particular the da Vinci Surgical System, were already being used in urologic, thoracic and abdominal procedures. They realized the potential value of the surgical robot for otolaryngological procedures. Over the next several years, Drs. Weinstein and O'Malley conducted research to demonstrate the efficacy and safety of the TORS technique. They proved the efficacy of the TORS procedures for cancer cure, without the potentially disastrous complications of the established otolaryngological techniques of open surgical resection and conventional endoscopic surgery. TORS afforded cancer cure with less operating time, blood loss, and complication frequency. In light of this data, the FDA approved the da Vinci system to perform TORS procedures in 2009. It is currently the only surgical robot FDA-approved for TORS.

Dr. Erica Thaler, also at the University of Pennsylvania, researched the applications of the TORS approach to patients with obstructive sleep apnea, and published her work in 2016. She found that a multilevel approach, including tongue resection and uvulopalatopharyngoplasty, increased airway space and oxygen levels in most cases. The newly minted procedure was found especially beneficial for patients without prior pharyngeal surgery.

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