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History of Transoral Robotic Surgery (TORS)PENN Medicine Makes History – Again:FDA Clears TransOral Robotic Surgery (TORS) – Developed at Penn by Drs. Weinstein and O'Malley – for Tumors of Mouth, Throat and Voice BoxDrs. Gregory S. Weinstein and Bert W. O'Malley, Jr., of the University of Pennsylvania School of Medicine's Department of Otorhinolaryngology: Head and Neck Surgery, founded the world's first TransOral Robotic Surgery (TORS) program at Penn Medicine in 2004, where they developed and researched the TORS approach for a variety of robotic surgical neck approaches for both malignant and benign tumors of the mouth, voice box, tonsil, tongue and other parts of the throat. The approach to developing TORS at Penn Medicine has been both scientific and systematic. Starting in 2004, the team at PENN began conducting feasibility experiments mannequins and cadavers and then moved on to animal models, all the while publishing their findings in the medical literature. Since 2005, approximately 350 Penn patients have participated in the world's first prospective clinical trials of TORS. These research trials compromise the largest and most comprehensive studies of the technology on record. 45,000 Americans and 500,00 people worldwide are diagnosed with Head and Neck Cancers — Transoral Robotic Surgery (TORS) may help improve outcomes in many of these patientsThe desire to perform TORS came from recognition that the standard surgical and non-surgical approaches the management of laryngeal, hypopharyngeal and oropharyngeal cancers, while in many way successful, had significant limitations. In addition the magnitude of the problem is high. 45,000 Americans and approximately 500,000 people worldwide are diagnosed with head and neck cancers each year. Head and neck tumor treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure; yet conventional surgery may require an incision across the throat or splitting the jaw, resulting in speech and swallowing deficits for patients as well as more healing and therefore slower recovery. In comparison, the minimally invasive TORS approach, which accesses the surgical site through the mouth, has been shown to improve long term swallowing function and reduce risk of infection while speeding up the recovery time. When compared to traditional surgeries, after their cancers have been removed successfully, patients have been able to begin swallowing on their own sooner and leave the hospital earlier. TORS outcomes are markedly improved when compared to standard chemotherapy, radiation or traditional open surgical approaches for oropharyngeal cancer. Sharing our ideas and teaching has been and continues to be a major goal of our work in TORS at the University of Pennsylvania. We firmly believe that if these techniques are not "teachable," then they are of limited value. Stemming from this strong believe and interest in teaching, we initiated a TORS training program early on in our process of developing and advancing TORS. The first TORS training Workshop was held in October of 2006, at the corporate headquarters of Intuitive Surgical, Inc (Sunnyvale, California) The workshop was the first use of the newly opened da Vinci surgical system training lab. Twelve surgeons attended the training workshop led by Drs. Weinstein and O'Malley, The workshop was essentially a short didactic session followed by a full day of cadaver dissection in the six station lab. We then shared copies our IRB protocol from The University of Pennsylvania and helped them initiate their own clinical research program in TORS at their home institutions.. We were pleased that nearly all of the attendees at our workshop were successful at starting TORS research protocols. We Teach the Teachers — The vast majority of with surgeons who have established TransOral Robotic Surgery (TORS) programs in the United States were Trained by Drs. O'Malley and WeinsteinPrior to FDA clearance of TORS we have been limited in our ability to train other surgeons from the United States until the use of the da Vinci robotic system has been cleared. The interest however, among surgeons in the United States has been very high. With the FDA clearance ( December, 2009) of the da Vinci System for transoral otolaryngology, Penn Medicine will immediately expand its well established training program to include surgical teams from the United States. With respect to international training efforts, however, we have had an active international training program at the University of Pennsylvania since November of 2007. The course has been a week-long experience that has included observation in the operating room and outpatient office as well as robotic certification in our training lab. We have trained numerous teams from 12 countries across the globe, most of whom have returned home and established active programs in TORS. While not all of the teams doing TORS internationally have been trained at the University of Pennsylvania, we encourage surgeons to take advantage our training program as they will learn key techniques and OR processes that will save them much time and will help them overcome the obstacles that can arise with the initial use and application of any advanced technology. With respect to popularization of TORS, the numbers of cases as per 2009 worldwide have been steadily increasing.
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