Trans oral robotic surgery (TORS) for head and neck cancer

This leaflet is for patients who are coming into hospital for TORS. It should help you to understand your hospital stay and the expectations for eating, drinking and pain management before your discharge.

What is the surgery?

TORS is a minimally invasive surgical technique used to treat conditions in the mouth, throat and voice box. It utilises advanced robotic technology to allow surgeons to operate with high precision through the mouth. This avoids external excisions and allowing the surgeon to access areas which are usually difficult to reach such as the base of the tongue, lower part of the tonsils and the area above the voice box.

The surgeon controls these instruments from a console, usually found in a corner of the operating room, and always has full control of the instruments in your mouth. An assistant surgeon will be next to you throughout the operation.

The benefit of TORS includes reduced recovery time and a shorter hospital stay. Your length of stay in hospital may vary from one to 10 days.

There are some risks associated with the surgery: There is a small risk of infection, bleeding, dental damage, altered sense of taste, swelling and the risks of general anaesthesia. Your surgeon may also undertake an operation in the neck to remove some lymph nodes but they will discuss this with you. In very few cases, a temporary tracheostomy (breathing tube in the neck) may be inserted at the time of your surgery to protect your airway until you have healed from the surgery. You will be shown how to look after this tube at home.

Depending on the extent of your surgery, you could be in the hospital for one to three nights; in more complex cases, your stay could be up to ten days.

It takes between two and three weeks to recover from surgery and we can give you a sick note to cover this period, should you require it.

What to expect following your procedure

Pain management

Pain relief medication will be provided. It is very important that you take these medications as prescribed to aid your recovery. It is very common to experience a painful mouth or throat after the procedure, which could persist for several weeks. Remember to take the stool softeners prescribed to avoid developing constipation.

We know that eating and drinking after the operation can be extremely painful and sore. In anticipation of this, we will place a temporary feeding tube (a nasogastric tube) into your nose so that we can feed you directly into your stomach and bypass your throat whilst healing begins. We will teach you how to care for this before the surgery.

What is a nasogastric tube?

A nasogastric tube (often called an NG tube) is a thin plastic tube that is inserted into one of your nostrils, down the back of your throat then down to your stomach. A feeding tube is used to provide nutrition and hydration to a patient. It can also be used to give medicines for patients who are having trouble taking them by mouth. The tube will be placed during the surgery by your surgical team. The NHS will supply all feed and equipment for the NG tube. We strongly advise that patients do not blend their own food to administer via the NG tube as this can block and damage the tube.

The position of the NG tube is checked every day before each feeding, including the length of the tube at the tip of the nose. Aspirate (contents of the stomach) pH is also checked before starting the feed. If the aspirate is very acidic (pH lower than 5.5), it is likely to have come from your stomach, meaning the NG tube is correctly positioned.

Who will look after the NG tube?

It is common that patients look after this type of tube themselves.

We aim to fully train you to use the NG tube before surgery. Where possible, your local nutrition nurse will come to your home to complete the training. If this is not possible, a CUH (Cambridge University Hospitals) nutrition nurse will arrange for an appointment to have the training at the hospital before your surgery. You are welcome to request training for any friends or relatives as well, please let a member of the dietitian team, CNS team, or nutrition nurses know so we can arrange this.

Unfortunately, district nurses are unable to provide support for caring with NG tubes.

Swallowing

Due to a combination of pain, numbness and swelling of the mouth and throat, eating and drinking is likely to be difficult following your procedure as explained above.

We expect this to improve over time as your throat begins to heal and the pain reduces. We encourage patients to maintain their swallow function by trying to swallow saliva as well as small sips of water, if this is advised by the surgeon. As you begin to heal, you will be able to increase the texture and volume of what you eat and drink. We suggest adjusting the consistency of the food you choose, for example starting with smooth blended foods such as yoghurts and custards and slowly moving up to foods that require more chewing.

There can be a risk that food and drink may go down the wrong way (into your airway, which could lead to a chest infection) following your procedure. You will be assessed and supported by a speech and language therapist if there are concerns about this. Please contact the team if you have concerns about your chest health once you begin to eat and drink.

Follow up after surgery

Your feeding tube will be removed when the team are happy that you can manage enough food and drink by mouth. This is likely to be done at a routine follow up appointment at the hospital.

You will be discharged with adequate pain relief and mouth washes. You should use these, and clean your teeth, regularly.

You should discuss with your surgeon about how long you will need to abstain from work. You will be given an appointment to come back to our clinic to see the team. They will talk to you about the pathology result from the surgery and whether any further tests or treatment are needed, such as radiotherapy.

You will be followed up for a total of five years by the head and neck team in hospital.

Medication

Bring all your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP when you come in for the surgery.

Please tell the ward staff about all the medicines you use during your stay. If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

Sign-up to MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: Sign up to MyChart.

Contacts/Further information

Head and Neck clinical nurse specialist 01223 217 425

Head and Neck Dietitians 01223 216 655

Head and Neck Speech and Language therapy 01223 216 200

References/Sources of evidence

ENT-UK Patient information leaflet on Transoral Robotic Surgery (TORS) (opens in a new tab)