Robotic surgery in otolaryngology

Robotic surgery is ushering in a new era in surgery by offering patients better outcomes and has already become one of standard modalities in urology and gynecology. In the otolaryngological field, after the FDA clearance in 2009, transoral robotic surgery (TORS) has now been widely adopted by head and neck surgeons for treatment of benign and malignant conditions of the pharynx and larynx. TORS has also been adopted for treatment of parapharyngeal tumors, sleep apnea, recurrent nasopharyngeal cancer, retropharyngeal node metastasis. Another use of surgical robots in otolaryngology is thyroidectomy and neck surgery. Robotic thyroidectomy has been developed mainly by Korean surgeons and the technique evolved into robotic neck dissection. Despite the 2nd biggest market of surgical robots in the world, the access to surgical robot for otolaryngology is very limited in Japan because da Vinci has not been approved for otolaryngological field by pharmaceuticals and medical devices agency (PMDA) yet. Multi-institutional clinical study of TORS is currently conducted in order to clear PMDA. The limitations and future directions of surgical robots in otolaryngology are also discussed.