Neil D. Gross, MD, Editor

F. Chris Holsinger, MD, Editor

This issue of Otolaryngologic Clinics of North America highlights the promise of robotic technology in otolaryngology. The role of robotics in otolaryngology has centered on transoral robotic surgery (TORS). The incorporation of TORS for benign and malignant neoplasms of the oropharynx has been palpable and is likely to expand, particularly for the treatment of obstructive sleep apnea. The role of robotics in otolaryngology beyond TORS remains uncertain.

The current platform for robotic surgery was not designed for use in otolaryngology. Therefore, there remain many challenges to implementing robotics in our specialty. For example, current technology lacks the haptic feedback critical for many procedures and is poorly suited for single-site access (eg, through the mouth). The current instruments are also useful only for soft tissue surgery, thereby excluding the majority of otologic and rhinologic procedures. Robotic technology will undoubtedly advance, hopefully spurred by increased competition in the marketplace and platforms specifically designed for otolaryngologic applications. In this manner, the current robotic platform can be viewed like the first generation of cell phones that were primitive compared with today’s smartphones.

Regardless of technological advances, the rational incorporation of robotics in otolaryngology will require rigorous evaluation of outcomes and an honest appraisal by robotic surgeons in our specialty to define the potential added benefit of robotic assistance versus cost. Current NCI-funded clinical trials, RTOG 1221 and ECOG 3311, as well as smaller investigator-initiated outcome studies will play an important role in answering these questions. Thus, it is incumbent on leaders in robotic surgery in Otolaryngology to rise to this challenge by defining clear indications for robotic surgery as well as standardizing training and education for future robotic surgeons.