Transoral Robotic Surgery for Tonsillar Neoplasms

Transoral robotic surgery (TORS) allows surgeons to access tumors of the upper aerodigestive tract through a natural body orifice – the mouth. This technique has been most commonly applied for neoplasms of the tonsillar fossa and base of tongue. The reason for this site predilection is two-fold: neoplasms of the tonsil and base of tongue represent one of the most common subsites of cancer in the head and neck, and neoplasms in this area are amenable to exposure and resection with the currently available robotic instrumentation. The use of this technique, however, forces the surgeon to view the anatomy from a different vantage point. Head and neck surgeons are accustomed to approaching tumors of the oropharynx from lateral to medial. The transoral approach forces surgeons to consider the anatomy from the oral cavity and oropharynx medial perspective. This chapter discusses the evaluation and workup of patients with tonsillar neoplasms being considered for surgical treatment, the relevant anatomy, operative goals, robotic surgical technique, and clinical considerations of transoral robotic surgery for neoplasms of the tonsillar fossa.