Transoral robotic surgery using CO₂ laser in oropharyngeal squamous cell carcinoma: a clinical case series

Transoral robotic surgery (TORS) is an established surgical approach for oropharyngeal squamous cell carcinoma (OPSCC). Carbon dioxide (CO₂) laser offers high cutting precision and minimal collateral thermal injury, yet its use in TORS remains underreported. The purpose of this study is therefore to describe the first UK case series detailing the use of CO₂ laser via hollow waveguide in TORS.

Eight patients (six male, two female; mean age 60 years) presenting with either left tonsillar (seven cases) or right tongue base (one case) OPSCC underwent primary TORS resection with CO₂ laser at a tertiary UK head and neck centre between October 2020 and May 2024. Cases were selected based on tumour stage, anatomical suitability and patient preference. The CO₂ laser (SmartXide Trio, 3-10 W, ultra-pulse mode) was delivered via hollow waveguide mounted on one of the arms of the Da Vinci robotic system. Outcome measures included histological margin status, peri- and postoperative complications, swallowing function, and hospital length of stay.

All tumours were completely excised; two of the eight had close margins on the primary specimen but were clear on additional sampling. No intraoperative complications occurred, and all procedures were completed without conversion. All patients resumed oral intake without nasogastric feeding. Mean hospital stay was 2.75 days, with no airway compromise, catastrophic bleeding, or significant swallowing dysfunction.

CO₂ laser dissection in TORS for OPSCC represents a viable surgical approach with acceptable postoperative functional outcomes and may possibly demonstrate reduced thermal injury compared with monopolar electrocautery.