Most otolaryngologists are not familiar with the robotic system and therefore need an introduction to the technology. There is a learning curve involved with understanding and utilizing the technology and equipment. It is important for trainees to familiarize themselves with the technology, its advantages, and limitations. Further, trainees also have to familiarize themselves with the indications for using the robot in head and neck cases. Although beyond the scope of this chapter, a thorough understanding of the indications for TORS is critical to the success of the surgical procedures. As with other surgical procedures, appropriate mentorship is of great benefit in creating a working knowledge of surgical indications.

Didactics for TORS include textbook chapters from transoral surgery books such as this one, procedure and device educational videos available online (davincisurgeryco​mmunity.​com), device manuals, and procedure guides [4, 5]. Lastly, trainees must also review head and neck surgical anatomy from a transoral approach. This requires learning “inside-out” anatomy from the transoral approach, as most head and neck surgeons are used to an “outside-in” approach from the neck. This anatomic understanding is critical for performing safe and effective TORS and for recognizing contraindications to the surgery.

The da Vinci Skills Simulator provides familiarity with the da Vinci console and the three-dimensional environment. The simulator includes a series of exercises that consist of tasks that the surgeon completes using the console controls, geared toward improving general robotic surgery skills. Studies in other specialties have shown that the da Vinci Skills Simulator scores correlate with surgeon experience and that simulator training improves robotic surgery skills [6–8]. Simulator tasks help to develop skills such as camera movement, clutching, and wrist motion skills. While the simulations are not designed for transoral robotic surgery specifically, they allow for mastering basic skills behind the console that are applicable to TORS. Additionally, simulators are widely available, easy to use for trainees, and affordable for teaching institutions.

Trainees can practice basic robotic skills in an inanimate laboratory with simple tasks using the surgical robot. The laboratory allows trainees to use the same robot used in surgery, familiarizing them with the operative setup and instrumentation. Several institutions have shown the beneficial use of the inanimate laboratory for transoral surgical training for residents [2].

The final step of inanimate training is cadaveric dissection performed with the surgical robot. This allows for teaching of the inside-out anatomy, progression of surgical steps for transoral procedures, and hands-on training of the complex and advanced maneuvers performed during TORS.

When learning TORS for live patients, the first step involves working as the bedside assistant. TORS is based on a four-handed technique and is dependent on a good assistant. Being an active assistant allows the trainee to learn the anesthesia techniques, equipment positioning, room setup, and patient positioning necessary for efficient implementation of TORS. This also helps the trainee learn mouth retractor placement, arm and camera positioning, and control of bleeding with clip application. Much like the rest of surgical training, an astute bedside assistant is able to anticipate the console surgeon’s next step in the surgical procedure and the retraction of tissues needed. This enhances the trainee’s understanding of the procedure.

The second step is as the console surgeon with the TORS mentor being either on the other teaching console, at the bedside, or actively observing using the interactive screen. This allows the mentor to step in if the trainee is struggling through a step or if there are any critical structures at risk of injury. Training behind the console adheres to a stepwise progression of experience with proficiency in the first steps being required before advancing to the next steps. Various TORS procedures have been organized into a structured curriculum from the University of Pennsylvania, which can be considered a prototype for a console surgeon training program [3].