Department of Otorhinolaryngology

Otorhinolaryngology

TransOral Robotic Surgery (TORS)


The University of Pennsylvania TransOral Robotic Surgery (TORS) Research Program

In the fall of 2004, the Department of Otorhinolaryngology - Head and Neck Surgery at the Hospital of the University of Pennsylvania developed the world's first TransOral Robotic Surgery (TORS) Program. The department also started the world's first robotic skull base surgery program in the fall of 2005. This research, combined with research from two centers that were trained by Drs. Weinstein and O’Malley, was used by the Federal Drug Administration (FDA) to assess TransOral Robotic Surgery (TORS). In December of 2009 the FDA approved the use of the da vinci surgical system to perform TORS for selected malignant lesions of the throat and voice box as well as all benign disease. Since FDA approval has been achieved for TORS, research at PENN has focused on further refinement of these techniques. Our new TORS Sleep Apnea research program began in 2009.

For a Multimedia Introductory Presentation of TORS click here.

For patient information on TORS which was invented and developed at PENN and appointment information click here.

For more information about TORS Training and to view Procedure Videos please click here.

The University of Pennsylvania TransOral Robotic Surgery (TORS) Cancer Research Program

Obstructive sleep apnea (“sleep apnea”) is a disorder in which the soft tissues of the throat collapse on inhalation during sleep, causing disruption in the normal breathing process. Sleep apnea can be very problematic as the disruption in a patient’s breathing results in decreased oxygen delivery to the body’s tissues which in turn can cause  long-term damage to vital organs. Moreover, patients can experience significant fatigue from sleep disturbance. This fatigue may create additional problems such as  impairment on the job or risk in driving a motor vehicle. Sleep apnea has also been shown to significantly lower life expectancy.

The standard treatment for sleep apnea is to wear a CPAP mask, which improves the opening of the breathing passages by blowing pressurized air into the patient’s nose or mouth during inhalation, overcoming the tissue collapse that creates the apnea. Some patients (about 50%) are not able or willing to tolerate the mask. The alternative to CPAP is surgery. Traditionally, surgery has been centered on a procedure known as uvulopalatopharyngoplasty (UPPP), which includes removing the tonsils and trimming the palate. This works about 50-65% of the time to improve the apnea.

It has become clear in the past decade or so that the tissue obstruction also occurs at the base of the tongue in addition to the palate and tonsils. The tongue base obstruction component of sleep apnea may be one of the reasons why surgery on the tonsils and palate alone does not always work.  There have been various supplemental surgical procedures that have been devised to address the tongue base component and improve the success of a UPPP.

At Penn, we are building upon the surgical expertise gained through our pioneering work in robotic head and neck surgery and our development of the procedure called TORS for tongue base cancers to address the tongue base component of sleep apnea. Specifically, we are identifying surgical candidates who have tongue base level obstruction causing sleep apnea, and applying the TORS procedure to correct tongue base obstruction in addition to palate and tonsil obstruction.

Patients are assessed through in-office examination and review of recent sleep studies, MRI of the neck, and sleep endoscopy – a minor procedure where the patient has sleep induced by an anesthesiologist, and then is evaluated with a scope to identify the levels of tissue obstruction. If the tongue base is involved, then the patient is a candidate for TORS for sleep apnea.

The TORS Sleep Apnea procedure involves the surgery and a 3-5 day post-operative hospitalization. During the first 36 hours after surgery, the patient may require an endotracheal tube to protect against breathing difficulties. The duration of stay is dependent upon the patient’s recovery in terms of pain tolerance and reduction of soft tissue swelling. Full recovery is expected to take about three weeks. A post-surgical sleep study is obtained three months after surgery.

Patient’s who are interested in enrolling in the sleep apnea study should call Dr. Erica Thaler for an appointment at 215-662-4533. A current sleep study should be available for review at the time of the first office visit.