Transoral robotic surgery (TORS)

Invented at Penn Medicine, transoral robotic surgery (TORS) is the world’s first minimally invasive robotic surgical technique to treat mouth and throat tumors and conditions. It enables surgeons to access hard-to-reach areas through the mouth, eliminating the need for large, external incisions while preserving speech and swallowing functions. This means faster recovery, fewer side effects, and better overall outcomes compared with traditional surgery.

TORS is performed by surgeons and otolaryngologists (ear, nose, and throat specialists) trained in robotic-assisted surgery. Penn Medicine was the first medical center globally to offer TORS and conducted all the original research on this procedure.

TORS uses a state-of-the-art da Vinci® robotic surgical system to give surgeons a clear, magnified, 3D view of the throat and precise control of tiny surgical instruments. During transoral robotic-assisted surgery, the surgeon sits at a console beside you. They use high-definition cameras and instruments inserted through your mouth and into your throat. The robotic system mimics the surgeon’s movements. With a greater range of motion than the human hand, the TORS instruments are designed for exact cutting and stitching actions.

TORS may be an option if you have a condition in hard-to-reach areas of the mouth or throat. For example, if you have obstructive sleep apnea and can’t tolerate a CPAP (continuous positive airway pressure) machine, you might be a candidate for TORS surgery. Your provider will review your sleep study and perform an endoscopic exam to determine if TORS is right for you.

TORS may also be used if you have mouth or throat cancer and meet the following criteria:

• You’re healthy enough for surgery and general anesthesia. 
• Your tumor is accessible and can be removed through your mouth. 
• The cancer hasn’t spread extensively to the lymph nodes in your neck. 
• Your tumor isn’t in your jawbone or doesn’t extend too far into your tongue or throat. 
• Your tumor isn’t directly attached to major blood vessels or surrounding critical structures.

If you’re receiving cancer treatment, Penn Medicine specialists review your case to see if you’re a good candidate for TORS. This typically involves an office visit and often includes a staging endoscopy. During this procedure, our surgeons can examine your tumor and assess its spread to nearby tissues. We may also take a small tissue sample (biopsy) to confirm the diagnosis.

Even if you’ve already had a staging endoscopy through your referring otolaryngologist, our TORS experts may recommend another one to fully understand your condition. This helps us determine the best treatment plan for you.

During the TORS procedure, you’ll receive medication to help you sleep and ensure you’ll feel no pain. Your surgeon will use a retractor, which keeps your mouth open and creates space for the robotic camera and surgical instruments. They’ll then maneuver the robotic arms to locate and remove the benign or malignant tumor, or to treat other conditions like sleep apnea. The surgery typically lasts between one and two hours. Afterward, you’ll be moved to a recovery room.

Recovery from TORS is generally quick. Most people can return to their normal routine within two weeks. You might experience some temporary swelling and numbness in your tongue, especially if the surgery was complex. In rare cases, you might need a steroid medication or temporary breathing support (tracheostomy tube) to help with your recovery.

After treatment, you should be able to speak and eat comfortably within a couple of days. Hospital stays are usually short, typically two or three days. While uncommon, bleeding can occur after surgery so it’s important to be cautious for the first week or two and have someone with you for support.

TORS offers several benefits for people with mouth and throat conditions and cancers. This procedure often:

• Is less invasive with minimal scarring
• Reduces the need for additional treatments like radiation or chemotherapy
• Produces faster recovery times and shorter hospital stays
• Allows you to return to normal activities more quickly
• Reduces the risk of long-term swallowing issues
• Results in fewer complications and less pain
• Lowers the risk of infection and blood transfusions
• Avoids the need for a tracheostomy (a surgical opening to the windpipe)

While TORS is generally safe, potential risks include:

• Bleeding
• Swallowing difficulties
• Taste changes
• Wound complications
• Speech issues
• Blood vessel changes

Penn Medicine: Leading the way in TORS treatment

TORS has become the new standard of care for mouth and throat conditions due to its exceptional success rate. By choosing Penn Medicine, you’ll benefit from our extensive experience and expertise in performing complex robotic procedures.

• TORS pioneers: Penn Medicine was the first medical center worldwide to develop and perfect the TORS minimally invasive robotic surgery technique for mouth and throat tumors.
• Unmatched experience: The Penn Medicine team has performed more TORS procedures than any other team in the world.
• Superior outcomes: Our dedicated team of surgeons, anesthesiologists, nurses, and clinicians work together to achieve optimal patient outcomes.
• Clinical trials: Since 2005, more than 400 Penn Medicine patients have participated in the world’s first clinical trials of TORS. These research trials provide the largest and most comprehensive body of evidence on TORS.
• TORS educators: We train surgeons in this innovative technique, educating physicians who come from around the world to observe and learn about TORS.