What Is Transoral Robotic Surgery (TORS)?

If your doctor has mentioned transoral robotic surgery — TORS — as a possible treatment for your throat cancer, you are likely trying to make sense of what that actually means. The term can sound intimidating, and for most patients it describes something they have never heard of before their diagnosis. This article is meant to explain what TORS is, why it exists, who it is appropriate for, and what the experience looks like for a patient going through it.

Why Throat Cancer Surgery Used to Require Major Operations

To understand why robotic surgery is significant, it helps to know what came before it.

The oropharynx — the part of the throat that includes the tonsils, base of tongue, soft palate, and back wall of the throat — sits deep inside the head. It is not easily accessible from outside the body, and tumors in this region are surrounded by critical structures: the carotid artery, the jugular vein, nerves that control swallowing and the vocal cords, and the jawbone. For decades, the only reliable way to remove a tumor from the base of tongue or tonsil was through open surgery that required splitting the jawbone (a mandibulotomy), making a large incision in the neck, or removing portions of the throat through external approaches. These operations were effective at removing cancer, but they came with significant consequences — prolonged hospital stays, difficulty swallowing, altered speech, and long recoveries.

The underlying problem was one of access. The tools surgeons used — rigid instruments and flat-light endoscopes — simply could not be maneuvered through the natural opening of the mouth to reach and resect a deep tumor with adequate precision and control.

Robotic surgery changed that calculus entirely.

How Transoral Robotic Surgery Works

TORS uses a surgical robotic system — specifically, the da Vinci surgical platform — to perform a resection entirely through the mouth, with no external incisions to the jaw or throat. The surgeon sits at a console a few feet away from the patient and operates the robotic arms using hand controls and foot pedals. A high-definition, three-dimensional camera provides a magnified view of the tumor and surrounding anatomy that far exceeds what the naked eye can see in an open surgical field.

The robotic arms translate the surgeon's movements at a reduced scale, filtering out hand tremor and allowing precise tissue dissection in an extremely confined space. The instruments themselves can articulate and rotate in ways that a human wrist physically cannot, which is exactly the degree of maneuverability that deep oropharyngeal resections require.

At our program, I perform TORS using the da Vinci SP — the single-port platform. Unlike earlier robotic systems that required multiple separate instrument ports, the SP delivers three fully articulating instrument arms and a camera through a single cannula. This makes it particularly well suited to the confined geometry of the mouth and throat. The SP platform is available at only a limited number of centers in the region, and I have extensive experience with it for oropharyngeal cancer resections.

Who Is a Candidate for TORS?

TORS is most commonly used to treat cancers of the tonsil and base of tongue — the two most common sites for HPV-related oropharyngeal cancer, which is currently the most frequently diagnosed head and neck cancer in the United States.

Whether a patient is a good candidate depends on several factors. The tumor needs to be resectable through the mouth — meaning its location, size, and relationship to adjacent structures allow for adequate exposure and safe margins without requiring an external approach. Most early- and intermediate-stage oropharyngeal tumors can be addressed this way. Larger tumors that involve the carotid artery, the floor of the mouth, or other areas inaccessible transorally may require open surgery instead.

Patient anatomy also matters. A patient with very limited mouth opening or a prominent gag reflex that prevents adequate exposure under anesthesia may not be a good candidate for a transoral approach, regardless of tumor size.

TORS is almost always combined with a neck dissection — a separate surgery through the neck to remove the lymph nodes most at risk for containing cancer. This is typically done at the same operation, through a small incision in the neck crease. The lymph node pathology obtained from the neck dissection then helps guide decisions about whether additional treatment with radiation or chemotherapy is needed after surgery.

What the Surgery and Recovery Look Like

TORS is performed under general anesthesia. The operation itself typically takes two to four hours, depending on the extent of the tumor and the neck dissection. Most patients are admitted to the hospital for two to three days afterward.

There is no external incision on the throat or jaw. Patients may have a drain in the neck from the dissection, and some will have a temporary nasogastric feeding tube — a thin tube passed through the nose into the stomach — to allow for nutrition while the throat heals. Whether a tracheostomy is needed is determined on a case-by-case basis, though for most early-stage TORS patients it is not required.

The first one to two weeks after surgery involve some throat soreness and difficulty swallowing, which typically improve steadily. Pain is real but manageable, and most patients can take soft or liquid foods orally within a week or two. By four to six weeks post-operatively, the majority of patients have returned to a near-normal diet and level of function.

One of the most meaningful advantages of TORS is not just what it avoids — external scarring, jaw-splitting — but what it preserves. Swallowing function is substantially better compared to open approaches, and speech is generally unaffected. For HPV-positive oropharyngeal cancer patients, who are often otherwise healthy and can expect excellent long-term survival, quality of life after treatment matters enormously. Getting back to eating, speaking, and living normally as quickly as possible is part of what makes TORS an attractive option when it is appropriate.

TORS as Part of a Larger Treatment Plan

Surgery is often not the end of treatment. After the TORS specimen and neck dissection lymph nodes are analyzed by the pathologist, the results guide a recommendation for additional therapy. Patients with favorable pathology — clean surgical margins and a limited number of lymph nodes involved — may be able to complete treatment with a reduced dose of radiation, or in select cases may not require radiation at all. Patients with higher-risk features, such as cancer at the surgical margin or multiple involved lymph nodes with extranodal extension, will typically receive standard-dose radiation with or without chemotherapy.

This decision is made collaboratively at our weekly multidisciplinary tumor board at St. Luke's, where the surgical findings are reviewed alongside imaging and pathology by the full cancer care team. The goal is to match the intensity of adjuvant treatment to the actual risk — treating enough to cure, but not more than the patient needs.

Next Steps

If you or someone you love has been diagnosed with a cancer of the tonsil or base of tongue, or has been told that robotic surgery may be an option, I am glad to discuss whether TORS is appropriate for your specific situation. Understanding your options — including what surgery would involve and what recovery looks like — is an essential part of making an informed decision about treatment.

To schedule a consultation, you can reach our office at 414-649-3920.

Dr. Steven Sperry is a fellowship-trained head and neck surgeon specializing in head and neck cancer surgery and microvascular free flap reconstruction at Aurora St. Luke's Medical Center in Milwaukee, Wisconsin.