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SUMMARY Objective This prospective, non-randomised study documents our initial experience using the Flex ® Surgical System for transoral surgery in Italy. Methods All patients who underwent transoral robotic surgery using the Medrobotics ® Flex ® Robotic System (Raynham, MA, USA) between March 2018 and April 2019 were reviewed. Rates of successful surgery, surgical time and complications were evaluated. 43 surgical procedures were performed in the study. The average age was 62.56 years (range 36-90 years). The Flex ® system was used successfully in surgery of the base of the tongue, palatine tonsils, supraglottis, hypopharynx and glottis, which was the most frequent target. Results All procedures were successfully completed. There were no intraoperative or serious postoperative complications, with no cases of intraoperative haemorrhage. Conclusions This is the first study in Italy evaluating the use of the Flex ® system to safely resect lesions in the oral cavity, larynx and pharynx.

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