Robotic technology has been slowly integrated into various fields of medicine with few complications. Advances in oncologic technology through robotic surgery have aimed to reduce patient mortality while maintaining similar surgical outcomes as other older techniques [1]. When robotic surgery was first explored, Intuitive Surgical^® developed the da Vinci surgical robot for procedures originally in urology [2]. In recent years, robotic surgery has become smoothly incorporated into head and neck oncologic surgery.

Oropharyngeal squamous cell carcinoma (OPSCC) represents a significant problem in the head and neck cancer field, with 123,000 cases of malignancy each year [3]. Around the same time that OPSCC was recognized as a major burden in the field, a new technique of robotic surgery (TORS) was in the process of adaptation to the head and neck field by otolaryngologists at the University of Pennsylvania. Their aim was to facilitate transoral access to oropharyngeal cancers, in addition to other oral tumors. Since then much research has shown that TORS facilitates more rapid swallowing rehabilitation and a shorter hospital stay than other management techniques, essentially minimizing morbidity and mortality from the procedures [2].

Furthermore, numerous studies show TORS to be as safe as conventional non-robotic surgery methods (chemoradiation) with the same safety profile, and advances are constantly occurring to improve results [4, 5]. Due to the increasing demand for TORS in the head and neck field, it is necessary to increase the number of head and neck robotic programs in the country.

Once the idea of a program for training surgeons in TORS is introduced, the next step shifts toward training. Adequate training of new surgeons is the crux of a flourishing robotics program at any hospital. In past studies evaluating the value of TORS programs in hospitals, surgeon training and experience is closely linked to the efficacy of a new program in robotic surgery [6]. Formal training in robotic surgery leads to better patient outcomes and shorter operative times. Furthermore, robotic surgery training has shown no negative impact on patient outcomes or learning curves [6].

The main disadvantage in the feasibility of establishing a robotic surgery program lies in training residents. To date, there are only 17 training centers in the United States [7]. Access to these training centers for their surgeons is the main challenge for many hospitals vying to establish a program. However, once this challenge is met, it is not difficult to train residents and surgeons in TORS.

Training requires considerable investment of money from surgeons and/or sponsoring hospitals. The initial training revolves around product training and animal labs. Thereafter the training is on actual patients. Currently this training can be performed by established proctors from the device manufacturer or in the hospital from another robotic trained surgeon.

The establishment of fellowships in TORS after residency in Otolaryngology has been proposed but to date has not been met with much enthusiasm. The main reason being that Head and Neck Oncology Fellowships already have a dearth of applicants and splintering them into further robotic fellowships would reduce the pool of necessary candidates. A successful study evaluating the proficiency of learning basic robotic skills showed that once a benchmark model for TORS trainings is established, it is very simple to teach residents fundamental tasks in robotic surgery [8]. However, the trend seems to show training programs slowly being added, as they were for robotic surgery in Urology [6, 8].