Today, many patients with laryngeal cancer are treated through a minimally invasive surgical approach. Transoral Laser Microsurgery (TLM) is a standard technique used worldwide, for many years already, to treat cancer of the vocal folds and of the supraglottic larynx and hypopharynx.
There is an apparent debate on the contributions of TransOral Robotic Surgery (TORS), as indications and techniques are basically the same as in TLM. Why should we use robotics when it adds costs to the procedures?
The answer is quite simple, and takes us to the basics of TORS: vision and dexterity.
TORS is endoscopic (3D) tele-manipulated surgery.
Endoscopic vision is gradually replacing microscopic vision. Besides flexibility, it adds a huge potential for digital image processing. Obviously, the future of surgical vision goes this way.
And dexterity. In TLM there is a cutting straight beam (the laser) from a source out of the surgical field, and the surgeon has just one hand left to manipulate the tissue with a long rigid instrument. TORS is four-handed surgery (five counting the endoscope) and robotic instruments are like small surgeon´s hands, right on the surgical field.
Check the surgical videos.
Dissection of the hyoid bone is feasible with TLM, but very few surgeons would be capable of the dissection shown with conventional TLM. A voluminous supraglottic tumor is dissected with TORS and taken out in mono-block. This is standard surgery today, thanks to TORS vision and dexterity.
Or check the second video and just imagine the possibilities of adding a flexible laser to robotic instrumentation.
The difference is obvious for any surgeon with experience both in TLM and TORS.