About TORS

TORS is the pneumonic for trans-oral robotic surgery. It is a minimally invasive approach, carried out through the mouth, using surgeon controlled robotic arms. Various 5 mm and 8 mm instruments and a 3-D HD camera arm allow for surgical dissection, bleeding control, and suture or flap repair, if necessary.

The cancers of oropharynx (base of tongue, tonsil, etc), hypopharynx and supra-glottic larynx are the ones which benefit from this surgery.

cancer that benefits
Dr. Sandeep Nayak


MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),

Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

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MBBS, MS Surgery

    MBBS: JIPMER 2000-2005
    DNB : ENT
  • Fellowship in ENT,
    Head and neck surgery,
    Mazumdar Shaw Cancer Centre


MBBS, MS, Fellow in Head and Neck oncology

    MBBS from Government Medical college,Jammu(J & K)
    MS ENT from Governemt Medical college,Jammu(J & K)
    Fellowship in Head and Neck oncology , Kidwai Memorial Institute of Oncology
    Assistant surgeon in Kidwai Memorial hospital
    Head & Neck Onco, TORS

The Advantages Of Robotic & Laparoscopic Cancer Surgery Include

Non-Surgical Alternate Treatment

Presently most of the patients are undergoing chemotherapy and radiation(chemoradiation) due to lack of robot and skilled team. Though chemoradiation avoids surgery, there are many long-term complications that last lifelong.

  • Swallowing dysfunction -permanent feeding tube dependence in 19 -30% of patients
  • A constriction in foodpipe (Pharyngeal strictures)
  • Dry mouth which is life long
  • Chronic pain in the head and neck
  • Bone related problems (Osteoradionecrosis)
  • when chemo-radiation does not cure the condition or the disease comes back, the surgery is complicated.

These are the reasons why TORS is emerging as a major modality of treatment for these cancers.

Laser Surgery : How Does It Differ ?

Transoral laser microsurgery is also considered a minimally invasive approach with similar indications. However, there are many limitations to it. As the surgeon operates using long unstable instruments, the removal of cancer is usually not satisfactory. Laser is good for early cancers of larynx. However, for other cancers listed above, the utility of laser is questionable.

Who Are The Candidates For Tors?

The best patients for TORS generally include early tumors (smaller than 4 cm in size) of the oropharynx (base of tongue and tonsil) and laryngopharynx (supraglottis and pharyngeal wall). These patients do very well with TORS, many of the getting cure just with this surgery alone. Some may need further treatment like radiation with or without chemotherapy, however, the dose that would be required will be much lower and tolerable.Some selected patients with tumours larger than 4 cm may also benefit from TORS. However, these patients are selected carefully.

The patients who have had recurrence of cancer following chemoradiation or for tumors left behind after completion of chemoradiation had no hope before TORS came into picture. Today these patients do well with the help of this new technology.

If statistically significant risk to the neck for spread of tumor exists, or if clinically evident neck nodal disease is present, neck dissection is usually performed during or 1 to 3 weeks after the TORS procedure. This surgery can be performed by minimally invasive technique called MIND.

Following TORS and neck dissection, about 70% of patients can be spared chemotherapy and approximately 30% can avoid radiation treatment based on histologic findings. The radiation dose that is required also is much lower than the conventional. This avoids many of the long-term complications associated with conventional chemo-radiotherapy.