Transforming Head and Neck Surgery with Transoral Robotic Surgery (TORS)

At Jefferson, robotic-assisted surgery provides surgeon David M. Cognetti, MD, with a better view and more instruments to access tough-to-reach-and-see spaces using a minimally invasive approach performed through the mouth.

Dawn Hilarczyk was nearly 3,000 miles from home in San Francisco on business when her neck began to swell and she developed numbness on that side of her face. Unsure what was happening and fearing a possible stroke, she rushed to a nearby emergency room.

For several years, Dawn had experienced a dull, chronic aching in her neck. Then, the 32-year-old businesswoman lost feeling in the entire left side of her face – “an excruciating numbness,” she recalled.

After returning home to Nazareth, Pa., the wife and mother of three young boys began what she describes as a two-month ordeal visiting “tons of doctors” in an attempt to have the cause of her problem diagnosed and treated.

In January 2010, Dawn was referred to Thomas Jefferson University Hospitals and David M. Cognetti, MD, co-director of the Jefferson Center for Head and Neck Surgery.

CT scans and MRIs revealed a tumor of the parapharyngeal space – an area tucked deep behind the jawbone and adjacent to the back of the throat – a spot that is challenging for surgeons to see and reach using ordinary means. A biopsy came back with some positive news: the tumor was benign.

Still, Dawn required surgery to have the tumor removed.

But a traditional “open” surgery would be massively invasive. It would necessitate a large incision in Dawn’s neck. Moreover, Dr. Cognetti may have needed to move her jawbone out of the way to gain access to the tumor so as not to damage important surrounding structures, particularly the carotid artery, which ran behind the tumor and supplies blood to the brain.

Dr. Cognetti offered the young woman an alternative: robotic-assisted surgery performed from inside her mouth. The minimally invasive surgery – known as transoral robotic surgery or TORS – would enable the surgeon to access the tumor using flexible instruments and cameras from inside her mouth, an impossible task with a traditional open surgery.

Dr. David M. Cognetti with Dawn Hilarczyk

Dr. David M. Cognetti with Dawn Hilarczyk

“The robotic device allows you to see around the corners as well as use surgical instruments that mimic the wrist movements of the human hand to allow you to operate around corners as well,” Dr. Cognetti explained.

In Dawn’s case, “TORS allowed us to access [the tumor] through the mouth. … You simply couldn’t see well enough or have the proper instruments to do that safely in the past,” Dr. Cognetti said. “We were able to remove the tumor and get her home with no scars and no side effects.”

Dawn was able to go home after spending just two days recovering in the Hospital. After five weeks she was back to work in the beauty industry traveling and giving lectures.

Jefferson is one of the few hospitals in the Delaware Valley to offer TORS to treat cancers of the tongue, tonsil, voice box and throat. For patients like Dawn Hilarczyk, transoral robotic surgery provides significant advantages over traditional surgery, including quicker recovery times, reduced risk of long-term swallowing problems, less scarring and lower risk of infection.

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