Head and neck surgeons: Nishant Agrawal, MD, Elizabeth Blair, MD, Zhen Gooi, MD, Louis de Guzman Portugal, MD
From left to right: Surgeons Nishant Agrawal, MD, Elizabeth Blair, MD, Zhen Gooi, MD, and Louis de Guzman Portugal, MD, provide a range of surgical solutions to treat head and neck cancers, while helping patients maintain the best quality of life during and after treatment.

At the University of Chicago Medicine, one of our driving goals is to help cancer patients live longer and achieve a cure, while minimizing the side effects of cancer treatment. Transoral robotic surgery (TORS) is one approach we offer to appropriate patients with head and neck cancer.

TORS is an innovative, minimally invasive treatment option to remove head and neck cancers through the mouth, especially those related to the human papilloma virus (HPV). Traditionally, surgeons have had to remove these cancers with more invasive approaches (such as by splitting the jaw or throat) that result in longer healing times and more side effects. TORS can help patients achieve a quicker recovery and potentially better functional outcomes.

Surgeons at the University of Chicago Medicine are proficient in using TORS to remove head and neck cancers. During TORS, surgeons use precision robotic arms and high-resolution cameras that allow them to work with greater accuracy in small, difficult-to-reach areas, such as the back of the tongue (tongue base).

UChicago Medicine is one of only a few hospitals in the Chicago area that offers TORS to head and neck cancer patients. Our surgeons are specially trained in this advanced technique and understand which patients are the best candidates for TORS.

Additionally, UChicago Medicine is the only hospital in the Chicago region to offer TORS in conjunction with immunotherapy as a treatment for head and neck cancer, potentially avoiding the need to undergo traditional radiation and chemotherapy.

Traditional surgery to remove certain head and neck cancers may require an incision through the throat or the need to split the jawbone. With TORS, surgeons can remove selected tumors through the patient’s mouth. This offers the following benefits:

  • Shorter hospital stay
  • Faster recovery time
  • Less risk of damage to surrounding swallowing muscles
  • Less risk of long-term problems with speech and swallowing

Depending on the extent of their cancer, some patients may be able to avoid the need for full-dose radiation or chemotherapy after TORS.

You may be a candidate for TORS if you have one of the following cancers:

  • Cancer of the tonsil
  • Cancer of the tongue base
  • Head and neck cancers caused by HPV
  • Cancer that has spread from an unknown site in the body to the head and neck (known as metastatic cancer with unknown primary site, or cancer of unknown primary)

Our internationally recognized head and neck cancer team carefully evaluates each patient to determine if TORS is the best option. This multidisciplinary team includes head and neck surgeons, radiation oncologists, medical oncologists, pathologists, radiologists and speech and language pathologists. 

At UChicago Medicine, our patients benefit from our extensive experience treating the entire range of head and neck cancer cases. Our head and neck cancer team pioneered, co-developed or first implemented many innovations for this disease in the Chicago area.

Many patients have head and neck cancers that have spread from an unknown site in the body. Traditionally, these patients have received full-dose radiation therapy for their cancer. This can have serious side effects, including temporary and chronic issues with speech, swallowing, dry mouth and altered taste.

Using the TORS approach, surgeons often can identify the primary source of these cancers. Then surgeons can either remove the primary tumor or enable radiation oncologists to provide more targeted radiation at lower doses. This helps reduce the risk of speech and swallowing problems.

During TORS, the surgeon sits at a control panel in the operating room while the patient is nearby on the operating table. The control panel has a screen that shows 3D, high-resolution images of the patient’s tumor and surrounding tissues. The panel also includes controls that allow the surgeon to operate the robotic instruments to remove the tumor.

The robotic arms have instruments that allow for greater flexibility and range of movement. They also are tremor free compared with a surgeon’s hands. 

Following TORS, patients recover in the state-of-the-art Center for Care and Discovery on the University of Chicago Medicine campus. Patients may have a temporary feeding tube through their nose to provide additional nutrition. The day after the operation, patients typically can swallow liquids. A speech and swallowing specialist may teach strategies to make swallowing easier after surgery. A few days after TORS, most patients are able to advance to a soft diet.

Patients with head and neck cancer require close follow-up care after TORS. This includes regular visits with the head and neck cancer team for cancer surveillance. Some patients with early stage cancers may not require chemotherapy or radiation after TORS. Others may require chemotherapy, radiation or both.

Throughout the patient’s treatment, our goal is to provide effective, compassionate and patient-centered care.