Following the inception of transoral robotic surgery (TORS) in 2005, the field of robotic head and neck surgery has undergone refinement and innovation. Optimizing patient outcome, preserving function, and limiting morbidity are the key drivers. The next leap forward is another generation of flexible robotic surgical systems. Several such systems are under clinical and preclinical evaluation. A new single-port (Sp) robotic surgical architecture is now available integrating three fully articulating instruments and a flexible three-dimensional high-definition camera delivered through a 25-mm cannula. Preclinical feasibility studies of the Sp in human cadaver and porcine models suggest improved application compared to existing platforms for oropharyngeal and nasopharyngeal resection. With 3-handed manipulation of tissue, traction and countertraction may be used to deliver a more precise surgical dissection of head and neck anatomy than is currently possible. The single-port design permits greater access and maneuverability for the bedside surgical assistant. An alternative currently available in clinical use includes the Flex® system using a robotic camera and manually controlled endoscopic instruments. The Cambridge Medical Robotics Versius system is undergoing preclinical evaluation for TORS and may offer a novel modular approach. All of these systems allow the head and neck surgeon to reach further beyond the upper aerodigestive tract with greater agility and precision, expanding the boundaries of minimal access head and neck surgery.

Hinni ML, Lott DG: Contemporary Transoral Surgery for Primary Head and Neck Cancer. San Diego, Plural Publishing, 2014.
Hockstein NG, Nolan JP, O’Malley BW Jr, Woo YJ: Robot-assisted pharyngeal and laryngeal microsurgery: results of robotic cadaver dissections. Laryngoscope 2005; 115: 1003–1008.
Weinstein GS, O’Malley BW Jr, Hockstein NG: Transoral robotic surgery: supraglottic laryngectomy in a canine model. Laryngoscope 2005; 115: 1315–1319.
United States Food and Drug Administration: 510(K) Summary, Section III: Indications for Use for Intuitive Surgical Endoscopic Instrument Control System for Transoral Otolaryngology Procedures. Silver Spring, United States Food and Drug Administration, 2009.
Holsinger FC, Ferris RL: Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and future innovations. J Clin Oncol 2015; 10; 33: 3285–3292.
Kaouk JH, Haber GP, Autorino R, et al: A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 2014; 66: 1033–1043.
Holsinger FC: A flexible, single-arm robotic surgical system for transoral resection of the tonsil and lateral pharyngeal wall: next-generation robotic head and neck surgery. Laryngoscope 2016; 126: 864–869.
Tsang RK, Holsinger FC: Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system. Laryngoscope 2016; 126: 2257–2262.
Chen MM, Orosco RK, Lim GC, Holsinger FC: Improved transoral dissection of the tongue base with a next-generation robotic surgical system. Laryngoscope 2018; 128: 78–83.
Chan JYK, Wong EWY, Tsang RK, et al: Early results of a safety and feasibility clinical trial of a novel single-port flexible robot for transoral robotic surgery. Eur Arch Otorhinolaryngol 2017; 274: 3993–3996.
Moore EJ, Abel KM, Olsen KD: Transoral robotic surgery in the seated position: rethinking our operative approach. Laryngoscope 2017; 127: 122–126.
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