TranOral Robotic Surgery (TORS) for Laryngeal Cancer.
Updated Dec 2025
Cancer of the Laynx
Concept
Laryngeal cancer, most commonly squamous cell carcinoma, arises from the mucosal epithelium of the larynx and is frequently associated with risk factors such as tobacco use and alcohol consumption. It is anatomically classified into supraglottic, glottic, and subglottic tumors, each with distinct patterns of spread, lymphatic drainage, and prognostic implications. Glottic tumors often present early due to voice changes, whereas supraglottic lesions may remain asymptomatic until more advanced. Management depends on tumor staging and location and may involve transoral surgery, open partial laryngectomy, total laryngectomy, or non-surgical modalities such as radiation or chemoradiation. Organ preservation strategies (surgical and non-surgical) are prioritized where oncologically feasible, with careful consideration of functional outcomes related to voice and swallowing.
Management
Management of laryngeal cancer is typically coordinated through a multidisciplinary tumor board, which includes head and neck surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, and other specialized staff. Each case is reviewed comprehensively, considering tumor site, stage, pathology, comorbidities, functional status, and patient preferences. The team determines the most appropriate evidence-based treatment plan, which may include surgery, radiotherapy, chemoradiation, or a combination. The goal is to ensure oncologic control while maximizing functional outcomes, such as voice preservation and swallowing.
Transoral exposure
Adequate transoral exposure is a critical prerequisite for successful transoral surgery, particularly when targeting deep or distal structures such as the supraglottic larynx or hypopharynx. Achieving a clear, stable surgical corridor requires the use of specialized retractors.
TORS
TORS offers a minimally invasive approach for the resection of selected tumors in the supraglottic larynx and hypopharynx. Using the robotic system’s enhanced 3D visualization, tremor-free motion, and articulated instruments, surgeons can perform precise resections with en bloc removal with adequate oncologic margins. Benefits of the minimally invasive approach include reduced morbidity, shorter hospital stays, improved swallowing outcomes, and the potential to avoid tracheostomy or more extensive open procedures.
Patient safety
Patient safety is a transversal priority throughout the entire treatment process, guiding every clinical decision. The selection of candidates for TORS is based on a rigorous evidence-based approach, integrating tumor characteristics, imaging findings, and anatomical accessibility with current best practices and clinical guidelines. Not all patients are suitable for TORS. Treatment must be personalized, aligning oncologic goals with the patient’s overall health, functional status, and individual values and preferences. This is a patient-centered decision-making process. Ultimately, surgical expertise, institutional experience, and careful preoperative assessment are key to maximizing outcomes and minimizing risks.
Addendum. Transoral Total Laryngectomy.
Related posts:
- Transoral Robotic Total Laryngectomy: Why, When and How. Dic 23, 2025.
- Transoral Robotic Surgery (TORS) for laryngeal cancer. May 2, 2025.
- Transoral Robotic Total Laryngectomy. Aug 8, 2023.
- TORS Supraglottic Laryngectomy. Mar 20, 2022.
- Robotic Surgery for Larynx Cancer. Aug 29, 2020.
Treatment alternatives
Radiotheraphy / Chemoradiotherapy
For early-stage laryngeal cancer, radiotherapy is often a valid alternative to surgery, while chemoradiotherapy (CRT) is typically reserved for more advanced stages. The choice of treatment depends on the individual clinical scenario, including tumor characteristics, patient comorbidities, and functional considerations. When a functional partial surgery is feasible and can achieve clear margins, surgery is usually preferred, as it may eliminate the need for adjuvant treatment. However, if the patient would require postoperative CRT regardless—for instance, due to extensive nodal disease or massive cervical metastasis—upfront chemoradiotherapy is often the selected approach to avoid dual-modality toxicity. Patients requiring total laryngectomy are generally considered for organ preservation protocols with CRT, unless the disease is very locally advanced (e.g., T4 lesions), in which case radical surgery may offer better oncologic outcomes and survival benefits.
Open surgery and other minimal access options
Some partial laryngectomies cannot be performed using minimally invasive techniques and require an open surgical approach. For example, a supracricoid horizontal partial laryngectomy with cricohyoidoepiglottopexy (see image above), must be done through open access. When minimally invasive access is feasible, several alternative techniques are available. For many years, Transoral Laser Microsurgery (TLM) has been the mainstay for minimally invasive treatment of laryngeal cancer and remains the preferred technique for glottic tumors. In addition, there are other non-robotic endoscopic techniques that can be considered. However, any experienced surgeon will recognize the unique advantages of Transoral Robotic Surgery (TORS) over other minimally invasive methods, particularly for complex supraglottic or hypopharyngeal lesions, where improved visualization and instrument dexterity offer significant clinical benefits.
Surgical Videos
See also multimedia page
TORS comprehensive supraglottic laryngectomy (cadaveric dissection).
TORS comprehensive supraglottic laryngectomy (clinical case)
