Transoral Robotic Surgery in the Treatment of Head and Neck Cancer: Application and Prospect

Transoral robotic surgery (TORS) has reshaped the surgical management of head and neck neoplasms since its introduction in the mid-2000s, offering a minimally invasive transoral route to lesions of the oropharynx, larynx, hypopharynx, and nasopharynx. This narrative review synthesizes the technical foundations, current clinical evidence, and emerging directions of TORS, with explicit attention to study rigor and evidentiary hierarchy. Powered by the da Vinci platform, TORS provides magnified three-dimensional visualization and wristed instrumentation that enable en bloc resection with reduced external morbidity, shorter hospitalization, and the potential to spare or de-intensify adjuvant radiotherapy in selected human papillomavirus (HPV)-driven oropharyngeal cancers. For early-stage oropharyngeal disease, local control rates of 90–95% and disease-specific survival above 90% are consistently reported, and recent systematic reviews and large multicenter cohorts, including the international Recurrent Tumors of the Upper Aerodigestive Tract (RECUT) experience, confirm durable oncologic and functional outcomes in both primary and salvage settings, although randomized trials have yielded nuanced, sometimes divergent quality-of-life results. We appraise outcomes by anatomical subsite, the de-escalation trial landscape, complications and their mitigation, learning-curve dynamics, health economics, and the rapidly evolving integration of artificial intelligence in segmentation, augmented-reality navigation, intraoperative margin assessment, and outcome prediction. Recent evidence confirms that TORS is a valuable but expertise-dependent option whose benefit is greatest in carefully selected patients managed within multidisciplinary, high-volume pathways. We conclude by defining the principal unresolved questions and the evidence required to position TORS appropriately within contemporary multidisciplinary care.