Anesthetic management for transoral robotic surgery

The incidence of oropharyngeal cancer is increasing. Traditional treatments, including major open surgical resection, chemotherapy, and radiotherapy, are associated with significant patient morbidity - affecting the cosmesis, structure, and function of the head and neck. Transoral robotic surgery (TORS) is a minimally invasive technique that maximizes surgical visualization, accessibility, and maneuverability, avoiding transfacial or transmandibular access procedures (often involving tracheostomy and gastrostomy insertion), potentially resulting in improved long-term patient outcomes. Previously limited to specialist centers only, TORS has now been adopted by many institutions, such that all anesthesiologists should be aware of the unique requirements so that optimal perioperative care can be delivered wherever it is undertaken.

This article provides an up-to-date overview of the indications, contraindications, and potential benefits of TORS, preoperative considerations that distinguish it from anesthesia for other head and neck surgery, and the priorities for intraoperative and postoperative care (including prevention of complications such as bleeding and tongue edema).

While TORS appears to offer better functional and surgical long-term benefits to patients, its distinct perioperative requirements necessitate a thorough understanding, coupled with meticulous planning and implementation by a highly skilled, cohesive multidisciplinary team so that the advantages can be fully realized.