Transoral Robotic Surgery (TORS) for the Head and Neck: Current and Future Indications

Transoral robotic surgery (TORS) offers many technical advancements to existing endoscopic and transoral surgical approaches. This has faciliated a safer, less morbid and potentially more effective application of surgery to the management of both benign and malignant diseases in the head and neck. As this surgical approach gains widespread acceptance, it is important for all members of the treatment team to understand the strengths and current limitations especially when TORS is applied for malignant diseases. As of December 2009, Federal Drug Administration (FDA) has approved the use of the da Vinci® surgical system and TORS for selected malignancies of the oral cavity, pharynx and larynx and all benign disease. Of these sites, the greatest experience and longest duration of follow-up has been in the use of TORS for the management of oropharyngeal carcinomas where at least comparable oncologic outcomes and reduced long-term feeding tube dependency rates have been reported. Other anatomic sites where TORS has shown benefit based on preclinical studies and early human experiences include the larynx, hypopharynx, parapharyngeal space and infratemporal fossa for both benign and selected malignant tumors. Experience to date has demonstrated that the improved visualization with the robotic system offers the potential for improved oncologic resection with reduced morbidity. Based on present studies and outcomes data in conjunction with ongoing investigations, it is anticipated that TORS will make a major impact in the way we manage benign and malignant tumors within the head and neck and skull base.