Surgery through the mouth for laryngeal cancer (transoral surgery)
You might have surgery through the mouth for laryngeal cancer. This is also called transoral surgery. Or you may hear it called endoscopic resection.
About transoral surgery
You might have transoral surgery to remove an early stage laryngeal cancer. Or for some 
laryngeal cancers. Your surgeon aims to remove all the cancer with this type of surgery. You have this under a general anaesthetic.
When you have transoral surgery, your surgeon does not need to make any cuts (incisions) in your skin and neck. So you do not have any scars. This type of surgery helps to reduce possible problems with swallowing and speech that you might have after surgery. Surgery with cuts on your skin and neck is called open surgery.
Recovery from transoral surgery is often quicker than open surgery for laryngeal cancer.
Transoral surgery may not be suitable for everyone. For example, if you have neck problems, such as neck stiffness. Or you are not able to open your mouth widely enough.
Your surgeon will give you more information about this.
Types of transoral surgery:
- transoral laser microsurgery (TLM)
- transoral robotic surgery (TORS)
Transoral laser microsurgery (TLM)
A laser is a very thin, focused beam of light that heats and destroys tissue. Lasers can focus very accurately on tiny areas.
The surgeon puts a tube (endoscope) into your mouth and down your throat as far as your voice box. They use a laser to cut away the cancer. The laser is a fine, hot beam of light. It is attached to a microscope, so your surgeon can see the cancer very clearly. This is the most common type of transoral surgery.
Transoral robotic surgery (TORS)
Surgeons can use a special machine (robot) to help them with some types of transoral surgery. The surgeon controls the instruments robotically. They use cameras to see the area clearly. They then move the instruments very precisely to remove the cancer.
TORS is not available at all head and neck cancer centres in the UK.
Removing lymph nodes in your neck
You might have in your neck removed. This is usually at the same time as your laryngeal cancer surgery. Or you might have the lymph nodes removed another time. Your surgeon does this through a cut in the neck.
Having neck lymph nodes removed is called a .
Before surgery for laryngeal cancer
You will have tests to make sure you are fit enough for surgery.
Your will check your teeth and throat to check for possible problems in passing the tube (endoscope) into your mouth.
You usually see a speech and language therapist. They check your swallowing and speech and explain the possible problems you might have after surgery.
After transoral surgery for laryngeal cancer
You go to the recovery unit after surgery. You stay in the recovery unit until you are awake and well enough to go to your ward.
Your nurse regularly checks for any bleeding or swelling around the area where you had the surgery.
They also check your:
-
blood pressure and pulse
-
temperature
-
oxygen levels
You also have oxygen through a mask.
When you go back to the ward your nurse continues with these checks, but they become less frequent as you recover.
How long you stay in hospital depends on the type of surgery you have.
Pain control
After your surgery, you might have pain in your throat and neck. Your nurse will give you painkillers to help relieve the pain. You might also have mouth gargles. Let your nurse know if you are still having pain after taking the tablets.
Eating and drinking
Your nurse will let you know when you can eat or drink. This depends on the type of surgery you have.
Your speech and language therapist will help you with any swallowing problems. Your dietician will offer advice to help with any changes in your diet after your surgery.
After having transoral surgery you might need to have liquid food through a tube put down your nose into your stomach (a nasogastric tube) if you have difficulty swallowing. But most people will not need this. Your nurse removes the tube when your swallowing improves. Your surgeon will give you more information if you need to have a nasogastric tube.
You may need to continue to have a liquid or soft diet until you can manage your usual diet. This may take a few weeks.
Swelling around the surgical area
Swelling can make it harder to breathe. If there is a lot of swelling around the surgical site, you might need to have an opening or hole made in the front of your throat. This is made just above the voice box to help you breathe. It is called a tracheostomy and is usually temporary until the swelling goes down. It is not very common to have this after transoral surgery.
The surgeon puts a plastic tube into the hole to keep it open. The tube is a few centimetres long. A surgical ribbon or a cuff helps to keep it in place. Your surgeon will explain everything before your surgery if they think you might need this.
Your nurse carefully cleans the area and regularly checks it to make sure it is not red or swollen.
Removing a temporary tracheostomy
Your nurse removes the temporary tracheostomy tube when the swelling has gone down. They put a dressing over the hole.
They will show you how to look after the area until it has healed, this takes about 1 to 2 weeks. You may have a scar in the area where the opening was.
Effects of surgery on your voice
Surgery might affect your voice. Your surgeon might ask you to avoid speaking for a couple of days after your operation to allow the area to heal. Your voice may sound hoarse afterwards. The changes can be temporary but they can take a few weeks or longer to fully recover. Sometimes the changes can be permanent.
You may notice the sound of your voice changes towards the end of the day if you are tired. Very rarely you may lose your voice.
Your speech therapist gives you exercises to help your voice recover. They can also advise you on exercises to help you with any swallowing difficulties.
Getting up after surgery
It is important to get up and move around as soon as possible to help your recovery. Your physiotherapist might show you leg exercises to reduce the risk of blood clots.
Possible problems after surgery
There is a risk of problems or complications after any operation. Your surgeon explains these to you and the benefits of having the surgery.
Risk of bleeding
You may see some blood in your saliva or you might notice larger amounts of blood in your mouth. You must let your nurse or 24 hour hospital advice line know straight away if you notice any bleeding.
Infection
There is a risk of an infection with surgery, your nurse will tell you what to look out for and who to contact if you have symptoms of an infection. You should contact the number immediately if you think you might have an infection.
Symptoms can include:
- feeling generally unwell - not able to get out of bed
- a change in your temperature - 37.5°C or higher or below 36°C
- flu-like symptoms - feeling cold and shivery, headaches, and aching muscles
- a fast heartbeat
- feeling dizzy or faint
- being sick (vomiting)
Chipped teeth or bruised lips or gums
Occasionally, during transoral surgery, some people have chipped teeth or bruised lips or gums from the breathing tube put into their mouth. Chipped teeth can be repaired by a dentist if needed. Any bruising of the lips or gums will go down after a few days.
A weak or numb tongue
During surgery, the nerves around your tongue can be damaged, but this is rare. You might have problems moving your tongue or it might feel numb. Let your surgeon know if this happens.
