A 45-year-old male patient, known smoker and alcoholic is a follow up case of ca left tonsil treated with definitive chemoradiation 2 years back. Patient was on regular follow up and on routine direct laryngoscopy was found to have suspicious lesion in left glosso tonsillar sulcus. Biopsy from the lesion was done which confirmed the presence of cancer. Conventional surgery for his problem means a major surgery which included cutting open his lower lip is followed by cutting the jaw bone to gain access into the problem area and plastic surgery for reconstruction. Another option was giving radiation again but that would add on to the residual side effects which patient was having like decreased salivation and altered taste sensation.
Patient was offered robotic surgery, an innovative option which would avoid both the problems. A trans oral robotic surgery (TORS)which includes introduction of robotic arms inside the mouth of the patient along with the 3D camera. These robotic arms are controlled by the operating surgeon sitting in the console and procedure in conducted.
The lesion was successfully excised and sent immediately for testing (frozen section). The specimen was reported as cancer and further procedure was done as per the requirements.
Post op recovery was uneventful and patient was discharged on day 5.
Currently patient is taking oral feeds and with minimal pain.
Advantages of TORS
Current indications of robotics in head and neck tumors
1.Small tumors (T1and T2 cancer) inside the oropharynx (back of tongue and beyond that), hypopharynx and laryngeal (voice box) tumors.
2.Scar less surgeries for thyroid and parathyroid.
3.Scar less surgeries for early oral cavity tumors -neck dissection