Surgeons at the Singapore General Hospital (SGH) are now using the latest form of minimally invasive surgery to remove hard-to-reach cancers of the throat, tongue and tonsils.

Using the da Vinci surgical robot, the procedure called TransOral Robotic Surgery or TORS enables doctors to access the tumor site through the mouth without having to make a large incision. The technique significantly reduces patients’ recovery time, helps to preserve their ability to speak and swallow normally and produces fewer complications.

Cancers of the base of the tongue, throat and tonsils are often difficult to treat with surgery because of their location. The most common symptoms are pain, a lump in the neck and difficulty in swallowing.

“TORS has broadened the options available to patients with certain benign and malignant tumours found in the head and neck area. In suitable patients, it has been shown to improve quality of life with equal or better cancer control results than the current treatment. With the use of robotics hands, surgeons are now able to perform intricate surgeries in a very small space with great dexterity,” said Dr Tay Hin Ngan, Consultant, Department of Otolaryngology, SGH.

In the conventional surgery, doctors would make a large cut, often from ear to ear and split open the jaw. At times, the voice box is removed to access the tumour area. The surgeries are often disfiguring and lead to swallowing and speech problems.

Due to the traumatic nature of the surgery, the common treatment methods are radiation, chemotherapy or a combination of both. While these therapy methods are able to preserve the organ, patients often suffer from side effects such as dry mouth, loss of parts of the jaw due to bone death and infection, swallowing difficulty and aspiration (spillover of saliva into the windpipe and lungs). 

On the other hand, the new TORS technique enables surgeons to remove certain tumours through an effective and minimally invasive manner. With the help of the da Vinci Robot, surgeons are able to directly access the tumour site through the mouth, without cutting open the patient’s face.

During the procedure, surgeons sit at the console, manipulating the robotics hands in different directions. Small tools can be attached to the robotic arm, vastly improving the dexterity of the surgeons’ hands. The view of the tumour site can also be magnified ten-fold while the binocular cameras provide three-dimensional views.

Patients treated with this new technique will generally have shorter hospital stays and will be able to leave within days after surgery, compared to a week or more in the hospital after conventional surgery. Preliminary data indicate that they swallow better and have fewer problems with speech after surgery. It often takes patients months after conventional surgery to regain the ability to swallow normally.

Since September this year, surgeons at SGH have performed two surgeries using the TORS technique for head and neck cancer. The Department has also led the way with the use of the TORS technique for the treatment of Sleep Obs