Overview

Robotic head and neck cancer surgery is a minimally invasive procedure. Trans-oral robotic surgery is a type of such surgery where small robotic arms are passed through the mouth of the patient. It has been gaining popularity recently as it is less intensive in nature and has lesser side effects.

Conditions for which head and neck robotic surgery is considered are:

Throat cancer (tonsil, palate and tongue base)
Larynx (voice box) cancer
Tonsil cancer
Thyroid nodules
Neck lumps

Alternate Name

TransOral Robotic Surgery (TORS)
Robot-assisted head and neck surgery

Body Location

Head and neck region

Procedure

Treatment for head and neck cancers is quite challenging as it invariably affects speech and swallowing of the patient. Surgery is the preferred treatment option for majority of these lesions. Depending on location, sometimes radiation or chemoradiation may also be considered for treatment of these cancers. However, all of them impact the patient functionally. However, recent advances in technology have made treatment easier with the help of a surgical robot. It allows us to perform these surgeries in a minimally invasive manner.

During a Trans-oral robotic surgery,

You are anaesthetized or put off to sleep for the procedure
The surgeons then slide the camera and robotic arms through your mouth to reach the region affected by cancer.
The robotic arms carry small instruments, which are used to perform the surgery.
The malignant tissues are removed while making small cuts, and eventually, the gaps are closed in the remaining tissue

Robotic surgery for head and neck cancer is a high-definition procedure, and surgeons have a magnified 3D vision with a camera. The small instruments give more freedom enabling the surgeons to use these instruments in confined regions that are difficult to reach otherwise, these also prevent chances of surgeon fatigue.

Preparation

In preparation for robotic surgery for head and neck cancers, doctors often recommend discontinuing blood thinner medications 5 days before the surgery. You may also be asked to stop herbal medications and vitamin supplements 10 days before surgery. You will be asked to lose excess weight and make lifestyle modifications, including quitting smoking, limiting alcohol intake and leading a healthy lifestyle. A pre-anaesthesia check up is done before surgery to assess your fitness for the procedure. You are not allowed to eat or drink anything 8 hours before the surgery

Procedure Type

Surgical

Risks

Complications during or after a robotic head and neck cancer surgery include:

Abnormal bleeding (haemorrhage)
Aspiration occurs due to entering food or liquid into the lungs.
Respiratory compromise in which the lungs do not take enough oxygen
Difficulty swallowing (Dysphagia)
Difficulty breathing (resolved by tracheostomy)
Injury to teeth or lips

Follow-up

Follow-ups with the surgeon are essential to monitoring the recovery. However, you should immediately contact your surgeon if you observe signs of the following:

Bleeding
Fever
Abnormal swelling
Dehydration
Difficulty in swallowing and breathing
Vomiting and nausea

Recovery

A recovery plan after the procedure is often tailor-made for individual patients. However, general instructions often include the following:

Staying in the hospital for a few days
A feeding tube may be used after extensive surgeries to help you meet your nutrient requirements before you can eat normally again.
A drain may be placed in your neck for a few days
Some patients may need a tube in their neck for breathing
Resting for a few weeks, after which you may resume everyday activities

Home care instructions would include:

Resting for a couple of weeks and avoiding any strenuous activities
Eating easy-to-swallow foods
Taking pain or constipation medications
Observing signs of infection, such as a fever
Watching signs of bleeding

FAQs

Following the clinical evaluation, several diagnostic tests may be employed to confirm the diagnosis of TOF. Common diagnostic tests include:

Follow-up plans are suggested after the surgery. However, it is essential to contact your surgeon immediately if you experience the following:

Abnormal swelling
Bleeding
Difficulty in breathing or swallowing
Fever
Nausea and vomiting

What are the benefits of robotic head and neck cancer surgery procedures?

There are several benefits of robotic head and neck cancer surgery, including:

Less pain during recovery
Lower incidence of visible scars
Lower downtime
Reduced blood loss
Shorter stays in the hospital
Reducing the likelihood of a tracheostomy in which a surgeon inserts a breathing tube through an incision
Decreased risk of long-term speaking or swallowing issues.

What are the disadvantages of robotic head and neck cancer surgery?

Some of the disadvantages of robotic head and neck cancer surgery include the following:

The technique is approved only for a limited number of conditions.
Not all patients are eligible to undergo robotic head and neck cancer surgery. Patients with advanced cancer are not eligible. You need to meet the head and neck surgeon to assess if you are suitable for such a procedure
It cannot be performed if mouth opening is less or other related factors make access difficult.

How does robotic head and neck cancer surgery enable surgeons to perform a more efficient procedure?

Greater precision: The robotic arm's movements are more controlled and can rotate in tight spaces.
Shorter operating times: An experienced surgeon can quickly perform these surgeries.
Better visualization: The camera provides 3D, magnified, high-definition views of the surgical area so that the surgeons can have an optimal view of the diseased areas

Is robotic head and neck cancer surgery the only procedure you will need?

Cancer treatment often includes:

Reconstructive surgeries: To restore the appearance or functioning of the mouth and may involve tongue or throat repair to enable the patient to speak and swallow after surgery.
Neck dissections: Surgeons remove lymph nodes from the neck in cases where cancer has spread.

Who can perform robotic head and neck cancer surgery?

A surgeon trained in robotic-assisted surgery performs this type of procedure.

They may be specialists in:

Head and Neck Cancer surgery (Head & Neck Surgical Oncologist)

Some surgeons have formal training through minimally invasive and robotic surgery fellowships. To become an expert in performing robotic head and neck cancer surgery, a surgeon must perform many procedures independently.