Head & Neck Cancer
Robotic Surgery
What is transoral robotic surgery?
Transoral robotic surgery or TORS is a minimally invasive procedure used to treat various benign and malignant head and neck conditions using a specialised robot device via the mouth. The robot is at all times controlled by a qualified robotic surgeon who is in the operating room with the patient.
The robot system has three parts:
- A console where the surgeon remotely controls the robotic arms.
- A robotic cart next to the patient with three arms positioned inside the patient’s oral cavity. One arm handles the tiny endoscopic camera, and two arms hold specialist miniature surgical instruments, all of which are controlled by the surgeon at the console.
- A high-definition 3D vision cart so that other members of the surgical team can see the operation.
How is transoral robotic surgery performed?
Like many throat operations TORS is performed under general anaesthetic. During a TORS procedure, A/Prof McGuinness uses a state of the art Da Vinci medical robot to operate within the confined spaces of the throat without the need to make any cuts or incisions on the neck.
What conditions can be treated using transoral robotic surgery?
TORS is most effective in the treatment of less accessible cancer including:
- Cancers of the tonsil, base of the tongue or the soft palate (oropharyngeal cancer)
- Benign Tumours of the oropharynx, the hypopharynx, and the larynx
- Cancers of the Voicebox (Larynx)
- Parapharyngeal tumours
- Obstructive sleep apnoea (OSA) if caused by enlarged tonsils and tongue base and has failed other forms of treatment such as CPAP
What are the advantages of transoral robotic surgery?
There are a number of advantages to TORS when compared to open surgery and endoscopic surgery. These include:
- High resolution, 3D optics and magnification allowing the surgeon unparalleled vision during the procedure
- Tiny “wristed” instruments give the surgeon an increased range of motion allowing us to operate in the confined spaces of the throat. Magnification allows enhanced surgical precision and eliminates tremor.
- No need for facial incisions
- Fewer complications
- Shorter hospital stays
What are the limitations of transoral robotic surgery?
There are a number of barriers to the wider use of TORS. These include:
- Cost. The cost of the robot for healthcare businesses as well as the ongoing maintenance fees and costs of disposable instruments are high, resulting in limited availability and in some cases, higher out of pocket costs for patients when compared to conventional surgery.
- The limited availability of Robotic technology particularly in the public health system
- Additional training and credentialling of surgeons performing TORS procedures means there are a limited number of ENT specialists who provide TORS as a treatment option.
Experience with transoral robotic surgery
A/Prof McGuinness has had extensive training in TORS and is a credentialled robotic surgeon. He was one of the first surgeons in Australia to perform robotic head and neck cancer surgery and provides TORS procedures for suitable patients at Chris O’Brien Lifehouse, St George Private Hospital and Campbelltown Private Hospital.