Robotic-Assisted Otolaryngologic Surgery

On  Nov. 4, 2010, PeaceHealth Medical Group otolaryngologist Abraham Sorom, MD, performed the first robotic-assisted throat cancer procedure in Oregon, outside of Portland. Transoral robotic surgery, or TORS, a minimally invasive, endoscopic approach to throat and neck surgery, was approved in December 2009 by the U.S. Food and Drug Administration for removal of tumors of the throat, tongue base, larynx and thyroid. Dr. Sorom and his colleague, Dennis Diaz, MD, were the fourth and fifth otolaryngologists in Oregon to be trained in the use of the da Vinci Si Surgical System to perform such procedures.

About 45,000 Americans are diagnosed each year with head and neck cancers. Treatment often involves a combination of surgery, radiation therapy and chemotherapy. 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. This approach can require an almost ear-to-ear incision across the throat or splitting of the jaw, resulting in disfigurement and speech and swallowing difficulties for patients. The minimally invasive TORS approach accesses the surgical site through the mouth and has been shown to improve long-term swallowing function and reduce risk of infection while accelerating recovery time.

Da Vinci manufactured a line of smaller instruments specifically for use in the throat. The system optics, 3D visualization and binocular view with depth perception are a vast improvement over the headlamp and hand tools surgeons used before, Dr. Diaz said. "There has never been a great way to access the throat and tongue without serious incisions," he said. "The only way to magnify was to lean in closer. Now we can see exactly what we're operating on."

Not everyone is a candidate for TORS. Tumor size, stage and location, as well as patient anatomy, help determine eligibility. The approach has significant benefits over traditional surgery, including less trauma to the body, reduced blood loss, less post-operative pain and discomfort, reduced infection, shorter hospital stay, faster recovery and less scarring. The technique is currently undergoing clinical trials for use in reducing tongue-base mass for treatment of sleep apnea.

Read a case study of the first transoral robotic lateral oropharyngectomy in Oregon outside of Portland.

Surgical Services

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TORS can obviate the need for disfiguring mandibulotomy.