UCSF Trans-Oral Robotic Surgery Program

Over the past decade, surgeons have utilized the da Vinci surgical robot (Intuitive, Sunnyvale, CA) for more precise, safer, minimally-invasive surgeries, particularly in the areas of urology, gynecology, and laproscopic abdominal surgery. Recently, a robotic-assisted surgical technique for the treatment of head and neck cancer was approved by the FDA. The technique, called Trans-Oral Robotic Surgery or TORS, involves the use of the da Vinci surgical robot to remove benign and malignant tumors of the throat. TORS is a minimally-invasive technique where a surgical robot, consisting of a three-dimensional high definition video camera and robotic arms with miniaturized instruments under the full control of the surgeon, is used to completely remove tumors of the pharynx and larynx through the mouth without external incisions. This year, a surgical team including Drs. Steven Wang, Ted Leem, and William Ryan performed the first TORS procedure at the UCSF Hellen Diller Family Comprehensive Cancer Center at Mount Zion.

According to Dr. Wang, the most common candidates for the TORS procedure include patients with small to medium-sized tumors of the tonsil, soft palate, and base of tongue. In the past, the conventional surgical approach to these tumors would typically require a large incision through the lip and jawbone in a lengthy operation frequently lasting 10 to 12 hours. These conventionally-treated patients often would remain hospitalized with feeding tubes for up to 2 weeks following surgery. Using the da Vinci robot for TORS, these same tumors can be removed more precisely and with less blood loss, due to improved visualization and the fine motion control of the robotic instruments. TORS patients can frequently resume an oral diet and go home from the hospital within 1 or 2 days.

Dr. Wang states that, “Of course the most important measure of any new cancer treatment is how effective it is in curing the cancer.” Early reports from other major hospitals around the country indicate that TORS patients have equivalent cancer control rates compared to both conventional surgery and radiation-based treatments and may have quicker recovery and improved swallowing function. “However,” says Dr. Wang, “like any new cancer treatment technique, it is important to continue to study the outcomes of patients in order to validate the findings of these early reports.” Drs. Wang and Ryan, in collaboration with other centers around the country, are actively accruing information on their own patients who have undergone TORS in order to analyze the efficacy, outcomes, and costs associated with this new tool for the treatment of head and neck cancer.

Notwithstanding the initial success of the new UCSF Trans-Oral Robotic Surgery program, Drs. Wang and Ryan believe that robotic surgery is an approach that must be selected appropriately. Not all head and neck cancer patients should be treated with TORS or even with surgery. Some patients are still best served by traditional open procedures (through the jaw and/or neck). All new head and neck cancer patients at UCSF receive evaluation by a multidisciplinary team that includes head and neck cancer specialists from otolaryngology-head and neck surgery, radiation oncology, medical oncology, and others, so that every patient is able to make an informed treatment choice. For those patients who will benefit from TORS, Drs. Wang and Ryan are pleased to be able to provide this exciting new treatment option.