Transoral robotic surgery (TORS) offers many technical advancements to existing endoscopic and transoral surgical approaches. This has faciliated a safer, less morbid and potentially more effective application of surgery to the management of both benign and malignant diseases in the head and neck. As this surgical approach gains widespread acceptance, it is important for all members of the treatment team to understand the strengths and current limitations especially when TORS is applied for malignant diseases. As of December 2009, Federal Drug Administration (FDA) has approved the use of the da Vinci® surgical system and TORS for selected malignancies of the oral cavity, pharynx and larynx and all benign disease. Of these sites, the greatest experience and longest duration of follow-up has been in the use of TORS for the management of oropharyngeal carcinomas where at least comparable oncologic outcomes and reduced long-term feeding tube dependency rates have been reported. Other anatomic sites where TORS has shown benefit based on preclinical studies and early human experiences include the larynx, hypopharynx, parapharyngeal space and infratemporal fossa for both benign and selected malignant tumors. Experience to date has demonstrated that the improved visualization with the robotic system offers the potential for improved oncologic resection with reduced morbidity. Based on present studies and outcomes data in conjunction with ongoing investigations, it is anticipated that TORS will make a major impact in the way we manage benign and malignant tumors within the head and neck and skull base.
Weinstein GS. Assessment of intraoperative safety in transoral robotic surgery. The Laryngoscope. Feb 2006;116(2):165-68.
Maintenance of hemostasis in transoral robotic surgery. ORL; journal for otorhinolaryngology and its related specialties. 2005;67(4):220-24.
Robotic skull base surgery: Preclinical investigations to human clinical application. Archives of otolaryngology—head and neck surgery. Dec 2007;133(12):1215-19.
Transoral robotic surgery (TORS): Glottic microsurgery in a canine model. J Voice Jun 2006;20(2):263-68.
Transoral robotic surgery (TORS) for base of tongue neoplasms. The Laryngoscope. Aug 2006;116(8):1465-72.
Transoral robotic surgery: Supraglottic laryngectomy in a canine model. The Laryngoscope. Jul 2005;115(7):1315-19.
Transoral robotic surgery: Supraglottic partial laryngectomy. The Annals of otology, rhinology, and laryngology. Jan 2007;116(1):19-23.
Transoral robotic surgery: Radical tonsillectomy. Archives of otolaryngology—head and neck surgery. Dec 2007;133(12):1220-26.
Robotic anterior and midline skull base surgery: Preclinical investigations. International journal of radiation oncology, biology, physics. 2007;69(2 Suppl):S125-28.
Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence. Archives of otolaryngology—head and neck surgery. Jul 2005;131(7):592-99.
Minimally invasive mitral valve surgery: From Port Access to fully robotic-assisted surgery. Angiology. Jan 2003;54(1): 93-101.
Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. Archives of otolaryngology—head and neck surgery. Jan 2003;129(1):36-43.
Carcinoma of the tongue base treated by transoral laser microsurgery, part one: Untreated tumors, a prospective analysis of oncologic and functional outcomes. The Laryngoscope Dec 2006;116(12):2150-55.
Oropharyngeal Cancer: A Case for Single Modality Treatment with Transoral Laser Microsurgery. Archives of otolaryngology—head and neck surgery. 1 December, 2009;135(12):1225-30.
Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma. The Laryngoscope 1995;105(1):53-60.
Transoral laser microsurgery (TLM) +/- adjuvant therapy for advanced stage oropharyngeal cancer: Outcomes and prognostic factors. The Laryngoscope. Sep 2009;119(9):1709-19.
Transoral Robotic Surgery: Radical Tonsillectomy. Archives of otolaryngology—head and neck surgery. 1 December, 2007;133(12):1220-26.
Postoperative radiotherapy for cutaneous melanoma of the head and neck region. International journal of radiation oncology, biology, physics. Nov 15, 1994;30(4):795-98.
Fasciocutaneous flap reconstruction of the tongue and floor of mouth: Outcomes and techniques. Archives of otolaryngology—head and Neck Surgery Dec 2002;128(12):1388-95.
A functional outcome swallowing scale for staging oropharyngeal dysphagia. Digestive diseases (Basel, Switzerland). 1999;17(4):230-34.
Long-term Percutaneous Gastrostomy Tube Dependence Rates in Patients Treated with Intensity-Modulated Radiotherapy for Oropharyngeal Cancer: The University of Pennsylvania Experience. ASTRO Multidisciplinary Head and Neck Cancer Symposium; 2009;Chandler, Arizona; 2009.
Transoral robotic surgery for oropharyngeal squamous cell carcinoma: A prospective study of feasibility and functional outcomes. The Laryngoscope. Nov 2009;119(11):2156-64.
Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results. Archives of otolaryngology—head and neck surgery. Jul 2005;131(7):583-91.
Transoral resection of tonsillar squamous cell carcinoma. The Laryngoscope. Mar 2009;119(3):508-15.
Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. The New England journal of medicine. 6 May, 2004;350(19):1945-52.
Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. The New England journal of medicine. 6 May, 2004;350(19):1937-44.
Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head and Neck Oct 2005;27(10):843-50.
Impact of Late Treatment- Related Toxicity on Quality of Life Among Patients With Head and Neck Cancer Treated With Radiotherapy. J Clin Oncol 1 August, 2008;26(22):3770-76.
A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol. Feb 2009;90(2):189-95.
Factors Associated with Long-term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and- Neck Cancer. International journal of radiation oncology, biology, physics. 15 July, 2008.
Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: Early dose-effect relationships for the swallowing structures. International journal of radiation oncology, biology, physics. 1 Aug 2007;68(5):1289-98.
Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose- effect relationship. Radiother Oncol Oct 2007;85(1):64-73.
Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg. Aug 2009;141(2):166-71.
Transoral robotic surgery for the management of head and neck cancer: A preliminary experience. Head & neck. 2009 Mar;31(3):283-89.
Transoral robotic surgery (TORS) in laryngeal and hypopharyngeal cancer. Journal of laparoendoscopic & advanced surgical techniques. 2009 Jun;19(3):361-68.
Surgical treatment of squamous cell carcinoma of the base of tongue. Head & neck. 2001 Aug;23(8):653-60.
Meta-Analyses of Chemotherapy in Head and Neck Cancer (MACH-NC): An Update. International Journal of Radiation Oncology* Biology* Physics. 2007;69(2, Supplement 1):S112-S4.
Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis. Lancet. 2006 Sep 2;368(9538):843-54.
Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: An RTOG analysis. J Clin Oncol. 2008 Jul 20;26(21):3582-89.
Radiotherapeutic management of surgical recurrences and postoperative residuals in tumors of the head and neck. Radiology. Apr 1970;95(1):185-88.
Transoral robot-assisted CO2 laser supraglottic laryngectomy: Experimental and clinical data. The Laryngoscope May 2007;117(5):817-20.
Supraglottic Laryngectomy. Organ Preservation Surgery for Laryngeal Cancer. San Diego, California: Singular Publishing Group; 2000.
Parapharyngeal space neoplasms. Head and neck. Mar-Apr 1995;17(2): 124-30.
Management of tumors arising in the parapharyngeal space. The Laryngoscope. Jun 1990;100(6):583-89.
Safety and efficacy of transcervical resection of parapharyngeal space neoplasms. The Annals of otology, rhinology, and laryngology. Dec 2001;110(12):1093-98.
New approach to the nasopharynx: The maxillary swing approach. Head & neck. May-Jun 1991;13(3):200-07.
Minimally invasive endoscopic nasopharyngectomy in the treatment of recurrent T1-2a nasopharyngeal carcinoma. The Laryngoscope. 2007 May;117(5):894-96.
Transoral robotic resection of recurrent nasopharyngeal carcinoma. World Robotic Symposium, Orlando, Florida; 2010.
Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report. ORL; journal for otorhinolaryngology and its related specialties. Feb 18;72(1):22-27.