TransOral Robotic Surgery (TORS): New Procedure Developed at Penn Changes the Treatment of Cancer

In December 2009, the U.S. Food and Drug Administration (FDA) approved the use of transoral robotic surgery (TORS) for the treatment of tumors of the mouth and throat in adults. TORS, a minimally invasive robotic-assisted surgical procedure, was developed at Penn in 2004. Beginning in 2005, more than 375 Penn patients participated in the world’s first clinical trials of TORS — the most comprehensive study of the trial on record.

Advancing Medicine

For more than 200 years, Penn Medicine has pushed the boundaries of medicine. Robotic-assisted surgery is the new frontier in modern medicine and Penn surgeons like Bert W. O’Malley, Jr., MD, and Gregory S. Weinstein, MD, co-directors of the Penn Center for Head and Neck Cancer at the Abramson Cancer Center at the University of Pennsylvania, are leading the way.

The introduction of the surgical robot led Drs. O’Malley and Weinstein to look for ways to apply the technology for treating tumors of the mouth and throat. Previous surgical treatments for cancer of the tongue, tonsil, voice box and throat involved making a large incision and usually caused patients a great deal of discomfort and scarring. Many patients had difficulty swallowing after the procedure and they often required extensive reconstructive cosmetic surgery.

The result was TORS. The arms of the surgical robot provide better access to small — and often difficult to reach — areas in the throat and mouth. The small size and dexterity of the instruments at the end of the surgical robot’s arms allow the surgeon to see and operate as if he were standing right next to the tumor — no matter where it is located.

Transoral robotic surgery, TORS, is used to treat malignant and benign tumors of the:

• Mouth
• Voice box
• Tonsil
• Tongue
• Throat

Gaining Approval

In order to receive FDA approval, Penn had to demonstrate success of the procedure as well as its teachability — could other surgeons learn how to perform TORS and have similar successful outcomes.

"TORS is very teachable," Dr. O’Malley said. "In the first month after the FDA clearance, we had calls from more than 80 physicians about the training."

Penn Medicine currently has the only TORS training program in the country. In April, Drs. O’Malley and Weinstein will hold a major national TORS training course during the World Robotics Symposium in Orlando.

Patients in the clinical trials experienced excellent results from TORS. The treatment was as effective as more traditional therapies, such as open surgery or chemotherapy and radiation, at removing tumors.

Clear Benefits for Patients

While the invention and development of TORS is a tremendous advancement in surgery, the greatest benefit of the procedure is the successful treatment of patients with tumors of the mouth, voice box, tonsil, tongue and areas of the throat.

When compared with traditional procedures, the benefits of TORS include:

• Quicker return to normal activity
• Shorter surgical time and hospitalization
• Reduced risk of long-term swallowing problems (more commonly seen with chemoradiation or traditional open surgery)
• Fewer complications compared to open surgery
• Less scarring than open surgery
• Less risk of infection
• Less risk of blood transfusion when compared to open surgery
• No routine use of tracheostomy during surgery (routinely used for open surgery)

Support from All Levels

The support and resources of Penn Medicine were crucial for successful development of TORS, according to Drs. O’Malley and Weinstein. Developing and introducing a new surgical technique to the world requires a comprehensive effort from system leadership, the school and the physicians.

TORS is an example of blending new technology with innovation. It represents the type of clinical translational research for which Penn Medicine is known.

"We look at each new medical advance as a platform for new things," Dr. O’Malley said.

"At Penn, we do more than buy the latest technology and use it. We buy it, then create, innovate and educate."