Transoral Robotic Surgery in Head and Neck Oncology: A Scoping Review of Evidence, Technological Advancements, and Future Trajectories.

Abstract

Robotic surgery has transformed head and neck cancer (HNC) treatment. This scoping review synthesizes evidence on transoral robotic surgery (TORS), focusing on applications, limitations, and future directions. Following PRISMA-ScR guidelines, this review used the PCC framework (Population: HNC patients; Concept: technological advancements; Context: any clinical setting). A systematic search of five databases and gray literature was conducted. Two independent reviewers screened records and extracted data from clinical trials and reviews. From 5411 records, 21 studies were included. Evidence confirms TORS provides excellent local disease control and functional benefits (e.g., shorter hospitalization, improved swallowing) over open surgery, albeit with a distinct complication profile (e.g., hemorrhage). A significant finding is the scarcity of high-quality randomized trials comparing TORS to radiotherapy or open surgery. Technologically, evolution from multiport to single-port and flexible systems has improved access, though limitations like absent haptic feedback persist. Emerging trends focus on AI integration for precision and developing smaller instruments. Robotic surgery is a viable, evolving approach for HNC with demonstrable functional advantages. Its future depends on overcoming technological limits, establishing cost-effectiveness, and validating efficacy through robust comparative studies. AI integration is a promising frontier for enhancing surgical precision and personalization.