Transoral robotic surgery: development and challenges

Abstract

The da Vinci Surgical robot has been marketed since 1999; it was originally designed for aiding complex laparoscopic operations and cardiac operations. By the mid-2000s, otolaryngologists had been attempting to deploy the surgical robot for endoscopic minimally invasive operations in the upper aerodigestive tract. The development went through a mannequin model, canine model, and cadaver model and finally cumulated to human Phase I trial. The operation was dubbed transoral robotic surgery (TORS). Subsequently, multicenter trials in the United States had proved the safety and oncological efficacy of using the surgical robot for resection of early cancers in the upper aerodigestive tract. In 2009, the US Food and Drug Administration granted license for the da Vinci surgical robot to be used for resection of benign tumors and early cancers in the oropharynx, larynx, and hypopharynx. TORS has also developed for surgery in the anterior skull base and nasopharynx, as well as in setting of flaps for reconstruction in the upper aerodigestive tract. This article will review the development of TORS, the current limitations, and future developments.