The first transoral robotic surgery (TORS) in western North Carolina has been performed at Wake Forest University Baptist Medical Center, and all three patients who underwent the first procedures are recovering well, without the complications that follow traditional surgery for the same diagnoses.
TORS, a minimally invasive, endoscopic technique, was approved by the Food and Drug Administration in December 2009 for removal of early stage (T1 or T2) tumors of the tongue base, throat, larynx and skull base. Traditionally those cancers have been removed through either an incision in the neck or through the mouth, which often requires splitting the lower lip and dividing the jaw.
Because tongue-base and throat tumors are difficult to reach through the mouth with conventional surgical instruments, the most common approach has been to remove them through external incisions. These are major operations, and may be painful and disfiguring, with long hospitalizations. Treatment alternatives such as chemotherapy and radiation therapy can have long-lasting side effects, such as swallowing difficulties, stricture formation in the upper esophagus and loss of salivary function.
“The TORS procedure allows us to access and remove tumors of the tonsil, tongue base and larynx endoscopically, resulting in a shorter, more comfortable recovery than with traditional surgical techniques," said Joshua D. Waltonen, M.D., assistant professor of otolaryngology and the surgeon who performed the first TORS at Wake Forest Baptist. "Patients may still need some postoperative radiation, but the dosage of radiation can often be reduced, and chemotherapy may be avoided. The severe side effects of radiation treatment are therefore minimized, resulting in quicker restoration of quality of life for these patients."
The TORS procedure employs the same da Vinci® Surgical System that is used for genitourinary surgical procedures, such as prostatectomies. The da Vinci “robot” includes a three-dimensional endoscope providing high-resolution images of the surgical site, with two or three additional robotic arms for surgical instruments. The surgeon sits at a console in the operating room and manipulates controls that translate the surgeon's hand, wrist and finger movements into precise, real-time movements of the surgical instruments.
J. Dale Browne, M.D., chairman of otolaryngology at Wake Forest Baptist, said he sees great promise for the TORS procedure for cancers of the tongue base, tonsil and larynx, especially in improving patients’ post-surgical quality of life. “Long-term, multi-institutional studies are needed to establish whether the TORS cure rates are as high as those of traditional therapies. But we’re very hopeful that this will lead to a fundamental change in the way we treat a lot of these tumors, and we’re very pleased to be among an elite group of academic medical centers offering this new procedure.”
For more information about the TORS procedure at Wake Forest Baptist, call (336) 716-4161.