Overview
Transoral robotic surgery involves a surgeon using a computer system to help guide the surgical tools. The tools are attached to a surgical robot. During this type of surgery, the tools go through the mouth. Transoral robotic surgery lets the surgeon work in areas of the mouth and throat that can be hard to reach or hard to see with other kinds of surgery.
Transoral robotic surgery often is used to treat mouth cancer and cancer that affects the part of the throat that's behind the mouth. Cancer that happens in this part of the throat is called oropharyngeal cancer. Transoral robotic surgery also can be used to treat other conditions, such as tumors of the mouth and throat that aren't cancer, as well as obstructive sleep apnea.
Transoral robotic surgery gives the surgeon a clear view of the surgical area. Using the robotic system to guide the tools, the surgeon can make very precise movements in tiny spaces in the mouth and throat. The system also allows the surgeon to be able to easily work around corners.
Transoral robotic surgery is a type of minimally invasive surgery. When compared with other types of surgery, transoral robotic surgery often allows for quicker recovery. It's also linked with fewer health concerns, called complications, that can happen as a result of surgery.
Why it's done
Transoral robotic surgery can be used to treat mouth cancer and cancer that affects the part of the throat that's behind the mouth. Cancer that happens in this part of the throat is called oropharyngeal cancer. Transoral robotic surgery often is used for early-stage tonsil cancer and cancer that affects the base of the tongue.
This type of surgery also may be used to remove tumors in the mouth and throat that aren't cancer. And it can be useful when part of the voice box needs to be removed, a procedure called a supraglottic partial laryngectomy. Transoral robotic surgery also may be used when the thyroid needs to be removed, a procedure called thyroidectomy.
Transoral robotic surgery sometimes may play a role in the treatment of sleep disorders such as obstructive sleep apnea.
Risks
As with any surgery, transoral robotic surgery has risks. These risks include bleeding, blood clots and infection. It's also possible to have a bad reaction to medicines called anesthetics that prevent pain during surgery.
Other possible risks of transoral robotic surgery include:
- Injury to teeth and lips.
- Tongue swelling.
- Problems with swallowing, speech or taste.
- An unusual opening or hole that forms between the area of the surgery and the skin of the neck. The medical term for this is a pharyngocutaneous fistula.
- Bleeding right after surgery or bleeding that happens days after surgery.
How you prepare
To prepare for transoral robotic surgery, follow any instructions you receive from your healthcare team. You may need to stop taking aspirin or other blood-thinning medicines several weeks before surgery. These can include warfarin (Jantoven), heparin and other medicines such as ibuprofen (Advil, Motrin IB, others). Do not stop taking any medicines without talking to a member of your healthcare team first.
You will need to stop eating or drinking for a certain amount of time before surgery. Your healthcare team gives you directions to follow before the procedure.
Most people stay in the hospital for several days after transoral robotic surgery. Arrange for a ride home when you leave the hospital and for someone to stay with you the first night you are at home.
What you can expect
Before the procedure
Before transoral robotic surgery, you meet with a surgeon to talk about the procedure. That meeting typically includes a review of your medical history. It's important to tell the surgeon if you smoke or if you have smoked in the past. Smoking can make a difference in the risks the surgery may have.
Imaging tests often are done before transoral robotic surgery to help with surgery planning. Imaging tests may include computerized tomography scans, also called CT scans, and magnetic resonance imaging scans, also called MRI scans. Tests also may include an imaging test that combines a positron emission tomography scan, also called a PET scan, with a CT scan.
During the procedure
During transoral robotic surgery, the surgeon sits at a remote-control console a short distance from the operating table. Surgical instruments are passed through the mouth to the area of the body where surgery is needed. The instruments are attached to a surgical robot that is controlled by the surgeon at the console. The surgeon precisely controls the motion of the surgical instruments using two control devices. The console displays a large 3D view of the surgical area that lets the surgeon see that area in much greater detail than is possible with other kinds of minimally invasive surgery.
After the procedure
A hospital stay is required after transoral robotic surgery. Most people are not able to eat anything by mouth for several days after surgery.
The area involved in transoral robotic surgery typically heals on its own over several weeks. It's common to have some pain when you swallow or to have trouble swallowing after transoral robotic surgery. But the pain often can be controlled with pain medicine. Difficulty swallowing typically goes away within about two weeks.
Results
Compared with other types of surgery, transoral robotic surgery generally offers excellent cure rates, shorter hospital stays and fewer complications. Ask your healthcare team what kind of results you can expect after transoral robotic surgery.