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So, transoral robotic surgery is a form of
surgery using a robot to access the oralpharynx.
So we've seen a rise in oralpharynx cancers in the United States,
most of which are HPV-related tumors of the tonsils and
the back of the tongue.
The robot offers us improved visualization so
that we can see the back of the mouth and the back of the throat.
Mainly, the tonsils and the back of the tongue, base of the tongue,
to remove tumors safely and without incisions from there.
Historically, we had to do larger surgeries which involved
scars and splitting the mandibula.
And so, with the robot, we don't have to do that.
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As we've said, there are a lot of patients with oropharyngeal cancer.
The incidents of patients with oropharyngeal cancers is rising in
the United States.
We know that these patients, the majority of them, are HPV positive.
And so based on work that we've done here, we've shown that HPV positive
patients have better survival than HPV negative patients.
So that means that they're living longer, and
living longer with the sequelae of treatment.
So in an effort to reduce the sequelae of treatment,
mainly from radiation and chemotherapy,
we're trying to use surgery upfront.
So we can reduce the amount of radiation
that's given to these patients, or reduce chemotherapy.
So patients with small tumors of the tonsil or back of the tongue who
are HPV positive are really the ideal patients for TORS.
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So the benefits of TORS are that we can pathologically stage a tumor.
So, when a patient comes in and we don't have pathology,
meaning we haven't removed the tumor, we can give them
a clinical stage based on our examination and imaging studies.
But, if we can perform TORS, that actually gives us the entire tumor,
the amount of nodes that are involved in the tumor.
And it gives us a more precise staging than we have from clinical
staging based on just clinical exam and imaging.
The other benefit of TORS is that we can potentially provide
a patient with just two modalities, surgery and radiation.
In some cases, surgery alone.
And not have to provide chemotherapy in addition to that.
In addition, we can sometimes reduce the dose of radiation after surgery.
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The recovery time, if we think about just doing the TORS part,
which is a big tonsillectomy, is really up to three weeks.
For adults, a tonsillectomy or even a lingual tonsillectomy, which is
removing the tonsils in the back of the tongue, is really painful.
And so we counsel patients that it's gonna take about three weeks until
they're pain-free.
It's very similar to a tonsillectomy when a kid undergoes it.
The other component of the surgery usually is a neck dissection.
Removal of the lymph nodes from the neck.
That's a much quicker recovery.
Patients generally leave the hospital the next day.
And the drain is removed within a week.
[MUSIC] So benefit are coming
to Johns Hopkins is that we offer multidisciplinary care.
We make a recommendation to patients before surgery,
whether not we think that they're good surgical candidate.
The radiation oncologist, the medical oncologist, and
the group of surgeons all help make that recommendation for patients.
Speech language pathologists are involved pre-operatively.
So, the multidisciplinary nature of it, I think is a huge benefit.
The other thing is that we know that patients who get treated at academic
centers, high volume tertiary care centers with subspecialized care,
have better survival outcomes than patients who don't get treated,
those kinds of centers.
The other reason is that we offer clinical trials based on
robotic surgery.
And so, patients would be eligible for TORS trials as well
as other clinical trials in conjunction with those trials.
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