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238:(AHI), the number of breathing obstructions or near-obstructions per hour of sleep, is one common way to measure the degree of a patient's sleep apnea. The higher the number, the worse the breathing during sleep. In a 2016 study of 75 patients, the average decrease in AHI post-TORS was 45%. Another 2016 study found an average AHI reduction of 51% in 11 patients. Researchers have also investigated the effect of TORS surgery for obstructive sleep apnea on swallowing function. A 2015 study of 78 patients found that oral feeding was resumed on average 1.05 days post-operatively, and not a single patient complained of long-term swallowing difficulty.
164:. A retractor is used to open the mouth to create room for the robotic camera and surgical instruments. The da Vinci patient-side cart is then brought to the bedside and the robotic instruments and camera are guided into the patient's mouth. Once the operation begins, the surgeon sits at the surgeon's console and views the patient's throat through a 3-dimensional scope. As the surgeon manipulates the instrument controls, the robotic instruments move deep inside the patient's mouth, and the operation is performed. Resection of tissue and suturing are accomplished with the advantages of the surgical robot at the back of the pharynx.
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these issues by avoiding the external incisions and sometimes reducing surgical time, both of which are associated with increased blood loss and infection. There are ongoing clinical trials collecting data on TORS, but numerous studies have repeatedly shown it to be both safe and effective in treating malignant tumors of the head and neck. Its use for the treatment of benign head and neck tumors has also been validated.
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tonsils is necessary, it can be removed in one of two ways. If the lingual tonsil tissue is large along the back of the tongue, it is shaved in a side-to-side direction . If the tongue is exceedingly large compared to the size of the throat, it is reduced by resecting tissue in the midline . Quantitative studies of patient outcomes are not yet available.
255:
In a study including data from 410 patients. This study demonstrated 91.8% 2-year locoregional control of the cancer, and 94.5% 2-year disease-specific survival. These numbers are similar to those of other head and neck cancer treatment options. A separate study of 62 patients found that 69% resumed
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TORS procedures offer many advantages to the alternative surgical techniques of open surgical resection and conventional endoscopic surgery. The current literature indicates that the TORS technique results in less blood loss, shorter hospital stays, and lower complication rates than open surgery. It
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The objective of TORSA (transoral sleep apnea) surgery is to increase the size of the air space leading from the mouth to the trachea. This can include removal of the tonsils, adenoids, uvula and edge of the palate, and/or part of the base of the tongue (lingual tonsils). When removal of the lingual
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and traditional open surgeries for some selected cases of pharyngeal and laryngeal cancers. Chemotherapy and radiotherapy are associated with long-term, potentially harmful toxicities, and open surgeries are highly invasive and prone to serious complications and extended hospital stays. TORS avoids
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Poissonnet, Valentine; Chabrillac, Emilien; Schultz, Philippe; Morinière, Sylvain; Gorphe, Philippe; Baujat, Bertrand; Garrel, Renaud; Lasne-Cardon, Audrey; Villeneuve, Alexandre; Chambon, Guillaume; Fakhry, Nicolas; Aubry, Karine; Dufour, Xavier; Malard, Olivier; Mastronicola, Romina (July 2022).
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Dr. Erica Thaler, also at the
University of Pennsylvania, researched the applications of the TORS approach to patients with obstructive sleep apnea, and published her work in 2016. She found that a multilevel approach, including lingual tonsillectomy (removal of the lingual tonsils, located at the
87:(voicebox) without any incisions through the neck, chin or lip (these incisions are necessary in traditional, non-robotic approaches). Current TORS indications include excision of tumors of the oropharynx (tonsils, soft palate, base of tongue, posterior pharyngeal wall), hypopharynx and larynx (
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procedures. Over the next several years, Drs. Weinstein and O'Malley conducted research to demonstrate the efficacy and safety of the TORS technique. They proved the efficacy of the TORS procedures for cancer treatment, with fewer complications and shorter hospital stays as compared to the
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Thaler, Erica R.; Rassekh, Christopher H.; Lee, Jonathon M.; Weinstein, Gregory S.; O'Malley, Bert W. Jr. (2016). "Outcomes for multilevel surgery for sleep apnea: Obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty".
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Arora, Asit; Chaidas, Konstantinos; Garas, George; Amlani, Ashik; Darzi, Ara; Kotecha, Bhik; Tolley, Neil S. (2016). "Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment".
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Eesa, Mohamed; Montevecchi, Filippo; Hendawy, Ehsan; D'Agostino, Giovanni; Meccariello, Giuseppe; Vicini, Claudio (2015). "Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation".
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Vicini, C.; Dallan, I.; Canzi, P.; Frassineti, S.; La Pietra, M.G.; Montevecchi, F. (2016). "Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: A preliminary report".
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Iseli, Tim A.; Kulbersh, Brian D.; Iseli, Claire E.; Carroll, William R.; Rosenthal, Eben L.; Magnuson, J. Scott (2009). "Functional outcomes after transoral robotic surgery for head and neck cancer".
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Gorphe, Philippe; Temam, Stéphane; Moya-Plana, Antoine; Leymarie, Nicolas; Kolb, Frédéric; Bout-Roumazeilles, Apolline; Qassemyar, Quentin; Benmoussa, Nadia; Honart, Jean-François (2021-06-06).
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Justin, Grant A.; Chang, Edward T.; Camacho, Macario; Brietzke, Scott E. (2016). "Transoral
Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis".
814:
Justin, Grant A.; Chang, Edward T.; Camacho, Macario; Brietzke, Scott E. (2016). "Transoral
Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis".
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Many studies have evaluated TORS patient outcomes and have found complications in 10-25% of cases. Most of these are minor, including dehydration, tooth injury, minor bleeding,
64:. This technique has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort and precision in remote-access areas.
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148:, increased airway space and oxygen levels in most cases. The newly minted procedure was found especially beneficial for patients without prior pharyngeal surgery.
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O'Malley, Bert W. Jr; Weinstein, Gregory S.; Snyder, Wendy; Hockstein, Neil G. (2006). "Transoral
Robotic Surgery (TORS) for Base of Tongue Neoplasms".
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Weinstein, Gregory S.; O'Malley, Bert W. Jr; Snyder, Wendy; Hockstein, Neil G. (2007). "Transoral
Robotic Surgery: Supraglottic Partial Laryngectomy".
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O'Malley, Bert W. Jr; Weinstein, Gregory S.; Hockstein, Neil G. (2006). "Transoral
Robotic Surgery (TORS): Glottic Microsurgery in a Canine Model".
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Weinstein, Gregory S.; O'Malley, Bert W. Jr; Hockstein, Neil G. (2005). "Transoral
Robotic Surgery: Supraglottic Laryngectomy in a Canine Model".
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Chabrillac, Emilien; Morinière, Sylvain; Jegoux, Franck; Blanchard, David; Choussy, Olivier; Hans, Stéphane; Vergez, Sébastien (September 2018).
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Solares, C Arturo; Strome, Marshall (2007). "Transoral Robot-Assisted CO2 Laser
Supraglottic Laryngectomy: Experimental and Clinical Data".
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Hockstein, Neil G.; O'Malley, Bert W. Jr; Weinstein, Gregory S. (2006). "Assessment of
Intraoperative Safety in Transoral Robotic Surgery".
1541:
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Chia, Stanley H.; Gross, Neil D.; Richmon, Jeremy D. (2013). "Surgeon
Experience and Complications with Transoral Robotic Surgery (TORS)".
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123:, were already being used in urologic, thoracic and abdominal procedures. They realized the potential value of the surgical robot for
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Hockstein, Neil G.; Weinstein, Gregory S.; O'Malley, Bert W. Jr (2005). "Maintenance of Hemostasis in Transoral Robotic Surgery".
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may result in a reduction of the rate of tracheostomy, while the indication for tracheostomy is still a matter of debate.
129:
1061:"Transoral robotic resection of benign tumors of the upper aerodigestive tract: Experience of the French group of GETTEC"
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Variations in the TORS technique are due to location of the cancer or obstruction and to the surgeon's preference.
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1448:"Transoral Robotic Surgery for Obstructive Sleep Apnea: Perioperative Management and Postoperative Complications"
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Mella, Mariam H.; Chabrillac, Emilien; Dupret-Bories, Agnès; Mirallie, Mathilde; Vergez, Sébastien (2023-03-16).
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Mella, Mariam H.; Chabrillac, Emilien; Dupret-Bories, Agnès; Mirallie, Mathilde; Vergez, Sébastien (2023-03-16).
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221:: This diagram shows how TORSA increases the airway size when the mouth is too small or the tongue is too large.
272:, tongue numbness and uncontrolled pain. Fewer patients develop major complications, which include hemorrhage,
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1256:"Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey"
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The TORS technique was first developed in 2004-2005 by Drs. Gregory Weinstein and Bert O'Malley Jr. at the
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136:. TORS afforded cancer cure with less blood loss and complication frequency. In light of this data, the
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The robotic instruments are placed in the patient's mouth, rather than through an external incision.
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210:: This diagram shows how TORSA increases the airway size when the lingual tonsils are too large.
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Weinstein, Gregory S.; O'Malley, Bert W. Jr; Snyder, Wendy; Sherman, Eric; Quon, Harry (2007).
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1346:"Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps"
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Hockstein, Neil G.; O'Malley, Bert W. Jr. (2008). "Transoral robotic surgery".
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803:. Penn Medicine Department of Otorhinolaryngology - Head and Neck Surgery.
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surgery utilizes the same approach to open the upper airway of those with
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The operation is performed with the technology of the surgical robot.
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approved the da Vinci system to perform TORS procedures in 2009.
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Current Opinion in Otolaryngology & Head and Neck Surgery
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oral intake prior to discharge, and 83% within two weeks.
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Weinstein, Gregory S.; O'Malley, Bert W. Jr. (2011).
91:...). Its use has been extended to approaches of the
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O'Malley, Bert W. Jr; Weinstein, Gregory S. (2007).
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679:Archives of Otolaryngology–Head & Neck Surgery
638:Archives of Otolaryngology–Head & Neck Surgery
634:"Transoral robotic surgery: radical tonsillectomy"
119:. At the time, surgical robots, in particular the
382:"Penn Medicine TransOral Robotic Surgery Program"
167:The defining aspects of the TORS technique are:
156:To begin a TORS/TORSA procedure, the patient is
759:Annals of Otology, Rhinology, and Laryngology
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1010:Byrd, J. Kenneth; Ferris, Robert L. (2016).
128:established otolaryngological techniques of
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191:TORS provides an excellent alternative to
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1405:Otolaryngology–Head and Neck Surgery
1303:Otolaryngology–Head and Neck Surgery
816:Otolaryngology–Head and Neck Surgery
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1547:Surgical procedures and techniques
603:10.1097/01.mlg.0000199899.00479.75
525:10.1097/01.mlg.0000227184.90514.1a
436:10.1097/01.MLG.0000170848.76045.47
99:. The TORSA technique is used for
67:In TORS and TORSA procedures, the
16:For other things named Torsa, see
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54:Transoral robotic surgery (TORS)
134:conventional endoscopic surgery
107:, and other airway procedures.
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1350:Journal of Clinical Medicine
1315:10.1016/j.otohns.2009.05.014
1223:10.1097/MOO.0b013e32832924f5
728:10.1097/MLG.0b013e31803330b7
692:10.1001/archotol.133.12.1215
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568:10.1016/j.jvoice.2005.10.004
303:Journal of Clinical Medicine
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801:"TransOral Robotic Surgery"
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1272:10.1007/s00405-021-07188-4
771:10.1177/000348940711600104
409:10.1016/j.otot.2008.03.005
251:TORS as a cancer treatment
187:Cancerous or benign tumors
117:University of Pennsylvania
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1465:10.1001/jamaoto.2014.2299
1175:10.1007/s00405-014-3480-x
1121:10.1007/s11325-015-1293-9
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358:TransOral robotic surgery
146:uvulopalatopharyngoplasty
101:uvulopalatopharyngoplasty
83:(back of the throat) and
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26:Transoral robotic surgery
1501:10.1177/0194599813503446
1417:10.1177/0194599816630962
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144:base of the tongue) and
121:da Vinci Surgical System
967:10.3390/cancers13112831
226:Obstructive sleep apnea
130:open surgical resection
62:obstructive sleep apnea
274:deep venous thrombosis
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18:Torsa (disambiguation)
360:. Plural Publishing.
280:, asphyxia or death.
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236:apnea–hypopnea index
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1363:10.3390/jcm12062303
1109:Sleep and Breathing
316:10.3390/jcm12062303
1552:Medical treatments
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278:pulmonary embolism
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260:Complications
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1537:Oral surgery
1492:
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960:(11): 2831.
957:
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866:(1): 22–27.
863:
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765:(1): 19–23.
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403:(1): 67–71.
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193:radiotherapy
190:
177:
166:
158:anesthetized
155:
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114:
66:
57:
53:
52:
1356:(6): 2303.
1022:(6): 1–12.
309:(6): 2303.
182:Indications
77:oral cavity
1531:Categories
284:References
97:skull base
89:epiglottis
1372:2077-0383
1280:0937-4477
1085:1043-3074
976:2072-6694
935:206202769
888:207655554
325:2077-0383
270:dysgeusia
266:dysphagia
132:and some
79:(mouth),
32:Specialty
1509:24013139
1474:25275670
1433:13739656
1425:26932967
1390:36983308
1381:10056198
1331:31522196
1323:19643246
1288:35066651
1240:17900923
1232:19342953
1183:25557003
1139:26669877
1093:29697873
1046:27117980
994:34204149
927:26153069
880:20173358
844:13739656
836:26932967
787:43831955
779:17305273
744:33544525
736:17473675
701:18086962
660:18086963
619:30810422
611:16467698
576:16472973
533:16885755
495:46748839
487:16145284
452:30860198
444:15995528
343:36983308
334:10056198
242:Outcomes
219:Figure 2
208:Figure 1
1517:3339804
1147:8939908
1037:5423354
985:8201082
954:Cancers
541:6816969
160:in the
111:History
81:pharynx
71:uses a
69:surgeon
1515:
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85:larynx
1513:S2CID
1429:S2CID
1327:S2CID
1236:S2CID
1187:S2CID
1143:S2CID
931:S2CID
884:S2CID
840:S2CID
783:S2CID
740:S2CID
615:S2CID
537:S2CID
491:S2CID
448:S2CID
42:[
1505:PMID
1470:PMID
1421:PMID
1386:PMID
1368:ISSN
1319:PMID
1284:PMID
1276:ISSN
1228:PMID
1179:PMID
1135:PMID
1089:PMID
1081:ISSN
1042:PMID
990:PMID
972:ISSN
923:PMID
876:PMID
832:PMID
775:PMID
732:PMID
697:PMID
656:PMID
607:PMID
572:PMID
529:PMID
483:PMID
440:PMID
362:ISBN
339:PMID
321:ISSN
234:The
95:and
1497:doi
1493:149
1460:doi
1456:140
1413:doi
1409:154
1376:PMC
1358:doi
1311:doi
1307:141
1268:doi
1264:279
1218:doi
1171:doi
1167:272
1125:hdl
1117:doi
1073:doi
1032:PMC
1024:doi
980:PMC
962:doi
915:doi
911:126
868:doi
860:ORL
824:doi
820:154
767:doi
763:116
724:doi
720:117
687:doi
683:133
646:doi
642:133
599:doi
595:116
564:doi
521:doi
517:116
475:doi
467:ORL
432:doi
428:115
405:doi
329:PMC
311:doi
195:or
138:FDA
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