Undergoing transoral robotic surgery (TORS) involves the removal of a tumor from the back of the tongue or throat and removal of the lymph nodes in the neck. The surgical robot is a tool that allows your surgeon to see and remove tumors through the mouth with optimal accuracy. This surgical approach decreases hospital stay and discomfort, while improving recovery time and the ability to swallow after surgery.

The Head and Neck Oncology team at the Mount Sinai Heath System has compiled the below postoperative care instructions for those undergoing TORS. These are general instructions, and may be subject to change based on your medical history and condition.

After Thyroidectomy Surgery Care

Wound Care: Your wound is covered with Steri Strips. Steri Strips are thin adhesive strips which are placed over an incision to help it heal. Keep the Steri Strips dry for the first 24 hours, and then you may gently cleanse the area daily with mild soap and water. You should avoid scrubbing or scratching the incision site. Leave them in place until they fall off on their own or your provider tells you to remove them. They will usually fall of the skin within 10 to 14 days. Try to keep them dry as much as possible to prevent infection.

Activity: You may resume most of your daily activities, although you should refrain from heavy lifting (greater than 10 lbs.) or strenuous activity. You can discuss when you may fully resume your daily exercise/fitness routines at your postoperative follow up appointment.

Diet: When you are allowed to take food by mouth, you will be started on a clear liquid diet while in the hospital. After 3 days of clear liquids either in the hospital or at home, you may be advanced to a full liquid diet for 3 days. After successfully tolerating a full liquid diet, you may advance to a soft diet as tolerated until you are seen at your follow up appointment. Please see sample diets below.

What to expect: You will have a sore throat and a hoarse voice after surgery. You should drink plenty of fluids, and it may be helpful to take throat lozenges to relieve your symptoms.  Symptoms may persist for a few days after surgery, but will improve over time.

Shower/Bathing: Unless indicated by your surgeon, you should be able to shower or bathe as usual.

Pain: For at least 10 days after surgery you should refrain from taking any ibuprofen (Advil, Motrin), Aleve, aspirin, etc., because these medications may cause bleeding. For pain, you should take Tylenol or the pain medication provided by your surgical team (unless otherwise directed by your surgeon).

Do not drive, operate dangerous machinery, or do anything dangerous if you are taking narcotic pain medication (such as oxycodone, hydrocodone, morphine, etc.) This medication affects your reflexes and responses, just like alcohol.

Call Your Head and Neck Surgeon If You Have…

1. Any concerns. We would much rather that you call your surgeon then worry at home, or get into trouble.
2. Bleeding: If it is just a few spots of blood in your sputum, rinse your mouth (gargle and spit) with cold water. Your sputum (saliva) should be clear. Call The Mount Sinai Hospital immediately for further instructions at 212-241-9410 (during business hours of 9am - 5pm, press 3, after business hours, press 0), or 212-844-8775 for Mount Sinai Union Square.
3. If you have persistent bleeding, hold pressure. If you are consistently coughing up blood or bleeding from your mouth, take two to three gauze, and press them firmly against the base of your tongue/tonsil palate as you were shown when you were given your postoperative instructions. Get emergency services right away. Contact 911 and state you have a bleeding emergency and/or go to the nearest Emergency Room. Contact your surgeon through our 24 hour on call service 212-241-9410 (during business hours (9am - 5pm) press 1, after business hours press 0).
   
   Do not delay contacting your surgeon or getting immediate emergency services. Delay in immediate care may result in acute blood loss requiring blood transfusions, additional surgical management or loss of life.
4. Fever over 101.5 degrees F.
5. Foul smelling discharge from your incision.
6. More than expected swelling of your neck.
7. Increase warmth or redness around the incision.
8. Pain that continues to increase instead of decrease.
9. Problem urinating.

If you have trouble breathing, you need to go directly to the Emergency Room without calling.

Sample Diets

Clear Liquid Diet: Clear liquid is any liquid that you can see through. This is used while the body is recovering from irritation or infection of the stomach or intestinal tract. It may also be used before special procedures or surgery. This diet is to be used no more than 3 days. Adults should drink a total of 2-3 quarts of liquid per day. It may be easier to drink small frequent servings rather than a few large ones. You may include the following items:

• Fruit Juices: strained orange juice or lemonade (no pulp), apple, grape and cranberry juice, clear fruit drinks
• Beverages: sport drinks (Gatorade, PowerAde, etc.), sodas, mineral water (plain or flavored), tea, black coffee, liquid gelatin (add twice the recommended amount of water)
• Soups: clear broth, consommé, bouillon
• Desserts: plain gelatin (Jell-O), popsicles, fruit juice bars

Full Liquid Diet: A full liquid diet is a middle step between a clear liquid diet and eating solid foods. A clear liquid diet allows only liquid you can see through. A full liquid diet allows thicker, liquid foods as listed below. The full liquid diet may be used before or after surgery or before some medical tests. It is easy to digest and leaves little food in the stomach and intestines. A full liquid diet meets calorie and protein needs for your body with liquids only. It should not be used for more than 5 days. Your doctor or nutritionist may also order high-protein, high-calorie supplements for extra vitamins and minerals. Adults should drink a total of 2 to 3 quarts of liquid per day. It may be easier to drink small frequent servings rather than a few large ones. You may include the following items on a full liquid diet.

• Beverages: coffee, tea, cream, milk, milkshakes, fruit and vegetable juices, sodas, mineral water (plain or flavored), liquid gelatin, electrolyte replacement sport drinks
• Cereals/Soups: cream of wheat, cream of rice, coco wheats, pureed soups (including pureed meats, bland vegetables and white potatoes), tomato puree
• Desserts: gelatin (Jell-O), whipped topping, custard-style yogurt, pudding, custard, plain ice cream, sherbert, sorbet, popsicles, fruit juice bars
• Miscellaneous: salt, mild-flavored seasonings, chocolate flavoring, gravy, margarine, sugar, syrup, jelly, honey, hard candy (to suck on)

Patients with severe kidney or heart disease can drink only limited amounts of fluids. Check with your doctor.

Soft Diet: A soft diet (also called s gastrointestinal soft diet, or bland diet) consists of foods that are soft in texture, mildly seasoned, low in fiber, and easily digested. This diet is for persons who have digestive problems. A soft diet reduces irritation of your digestive tract. Eat small frequent meals throughout the day, but stop eating 2 hours before bedtime. Follow any specific instructions from the healthcare provider about foods and beverages you can and cannot have. The general guidelines below can help you get started on this diet.

• Beverages: milk, tea, coffee, fruit juices, carbonated beverages, nutrition shakes and drinks
  AVOID: alcoholic beverages
• Breads/Crackers: refined white, wheat, or seedless rye bread, graham or soda crackers, Melba toast, plain rolls or bagels, very soft tortillas
  AVOID: whole-grain breads, rolls, or bagels with nuts, raisins, or seeds, crackers that are heavily seasoned, croutons, taco shells
• Cereals/Grains: cooked cereals, plain dry cereals, plain macaroni, spaghetti, noodles, rice
• AVOID: whole-grain cereals and granola, or cereals containing bran, raisins, seeds or nuts, coconut; brown or wild rice
• Fruits: avocado, banana, baked peeled apple, applesauce, peeled ripe peaches or pears, canned fruit (apricots, cherries, peaches, pears), melons, grapes
  AVOID: raw apple, dried fruits, coconut, pineapple
• Meat/Fish: all fresh meat, poultry, or fish that is cooked until tender
  AVOID: meat, fish, or poultry that is fried or prepared with seasonings that should be avoided (see below); tough or stringy meat including bacon, sausage, bratwurst, jerky, corned beef
• Eggs/Cheese: poached or scrambled eggs, cottage cheese, ricotta cheese, cream cheese, cheese sauces, or cheese melted in other dishes
  AVOID: crisp fried eggs, cheese slices and cubes, cheese made with seasonings that should be avoided (see below)
• Other Proteins: tofu, baked beans, smooth peanut butter or other nut or seed butters
  AVOID: deep-fried tofu, crunchy peanut or other nut or seed butters, nuts or seeds that are whole or chopped
• Soups: all soups without heavy seasoning
  AVOID: soups made with seasonings and foods listed in this sheet to avoid
• Vegetables: peeled and well-cooked potatoes or sweet potatoes; mildly flavored fresh, cooked, canned, or frozen vegetables without seeds, skin, or coarse fiber
  AVOID: raw vegetables prepared with spices that should be avoided (see below); corn; deep-fried vegetables (such as tempura)
• Desserts/Sweets: moist cake, soft fruit pie with bottom crust only, soft cookies moistened in milk or other liquid, gelatin, custard, pudding, plain ice cream, plain sherbet, sugar, honey, clear jelly
  AVOID: pastries, desserts, and ice cream that have nuts, coconut, seeds, or dried fruit; popcorn, chips of any kind including potato and taco chips; jam, marmalade
• Seasonings: salt, lemon and lime juice, vinegar, all extracts, sage, cinnamon, thyme, mace, allspice, paprika
  AVOID: whole fresh chili peppers, chili sauce or powder, pepperoncini, cloves, black and white pepper, seed spices, garlic, onions, leeks, horseradish, mustard, pickles, highly seasoned salad dressings

How to Contact Your Surgeon

For non-urgent inquiries, please call the Head and Neck Oncology offices during business hours, 9am to 5pm, Monday-Friday. If you need to speak with someone after 5pm or on a weekend, call the office, and the answering service will contact the doctor on-call to call you back.

Please note, pathology results are generally not available until 7-10 business days after your procedure. Results will be discussed in the office during your post-op visit.