Robotic Surgeries For Head & Neck Cancers

By Dr. Akshat Malik in Cancer Care / Oncology

Dec 22 , 2022 | 4 min read

Are robotic surgeries possible for Head & Neck cancers?

Yes, robotic surgeries are feasible for select Head & Neck cancers. Most performed is Trans-oral robotic surgery (TORS), where the tiny robotic arms go through the mouth of the patient and help in removing certain throat cancers. Other ways of access for robots include through the hairline behind the ears, through the axilla (armpits) or even from the inner/intra-oral aspect of the chin.

How are robotic surgeries for the Head & Neck region performed?

These are performed using a surgical robot. The robotic arms are introduced through the mouth, an inappropriate cut along the hairline, or the axilla. The robotic arms hold a high-definition endoscope and cutting and holding instruments.

The surgeon sits in a separate console where they get a high-resolution 3-dimensional picture of the operating field. The robotic arms are controlled from the console. These arms allow for cutting and removing the affected tissue in a precise manner without causing damage to the adjoining area. The arms are small and flexible enough to move around in the tiny area in a controlled manner.

What are the advantages of robotic surgery?

Robotic surgeries allow the surgeon to perform surgery precisely with less pain, blood loss, decreased chances of infection, reduced ICU stay and fewer days of hospitalization. All this translates into faster recovery for the patient. It also helps in eliminating the surgeon's tremors and fatigue.

In TORS, as the surgery is performed through the mouth, the patient does not need any external cuts or disfigurement. In other head and neck robotic surgeries (like neck dissection, thyroid, parathyroid, benign neck swellings, etc.), an inappropriate incision may be given, which avoids any visible scars. 

In cases of early oropharyngeal cancers, TORS may be the only treatment modality required or may help decrease the radiation dose required. It may obviate the need for adding chemotherapy to radiotherapy for advanced cancers. These decisions depend on several factors, including the aggressive features of the disease seen on the histopathology report and the recommendations of the multidisciplinary tumour board.

What is Trans-Oral Robotic Surgery (TORS)?

This is an advanced and innovative way of performing surgery, where the tumours are removed through the mouth of the patient. Tiny robotic arms go inside the patient's mouth, and the attached 3D high-definition endoscope allows a magnified view of the area.

The robotic arms are very dexterous and allow the removal of the tumour in a very precise and accurate manner. This prevents unnecessary damage to adjoining tissues. As the robotic arms go through the mouth, the patient need not have unnecessary dissection or cutting of bone to access the area inside the throat.

Which cases are suitable for TORS?

Certain cancers of the throat (tonsil, tongue base, soft palate), the supraglottis (upper part of the voice box), and parapharyngeal space may be suitable for excision via TORS. Sometimes, TORS may be used for salvage surgeries.

It may be used to excise select recurrence/failures/disease persistence following radiotherapy/chemoradiotherapy for oropharyngeal/throat (tonsil/tongue base) or nasopharyngeal (back of the nose), or supraglottis. The patient may have a neck node metastasis without a known primary site; in such cases, TORS may increase the chances of finding the primary tumour and provide a more focused treatment.

You need to be assessed by a head & neck cancer surgeon and the multidisciplinary team for suitability for TORS.

When can you eat and drink after TORS?

Generally, patients have a temporary feeding tube after a trans-oral robotic surgery. A speech and swallowing therapist part of the multidisciplinary team assesses and counsels the patient. Depending on the extensive resection, the patients may be started on clear liquids from the evening of the surgery or the next day. A soft diet may also be started earlier, within 2-3 days. 

What are the side effects of TORS?

The patient may feel sore throat or pain after the surgery. This is generally easily manageable with the painkillers and improves as the patient starts swallowing. There are chances of chipping off/loosening of the front teeth or some tongue swelling.

Like other oral/throat surgeries, there are chances of infection and bleeding after this procedure. Depending upon how extensive the resection has been, the patient may have some swallowing and speech-related difficulties. 

Will I have normal speech and swallowing after TORS?

As mentioned previously, depending upon the extent of resection, there may be some detriment in the speech and swallowing of the patient. Compared to open surgeries, such detriments are much lesser with TORS. Under the guidance of the Head & Neck surgeon, Speech & Swallowing Therapist and Dietitian, the patient gradually regains these functions. 

Why choose MICC Saket?

Max Institute of Cancer Care, Saket has a team of committed and focused individuals keen to make the patient better and disease-free as soon as possible and in a holistic manner. The multidisciplinary team includes a Head & Neck cancer surgeon, Radiation Oncologist, Medical Oncologist, Dietitian, Speech and Swallowing Therapist, Physiotherapist and Psychologist.

All the cases coming to the OPD are discussed in the tumour board to decide what is best suited for the patient. The patient's suitability for robotic surgery is assessed, and they are advised about all other alternative treatment options.