Reflections from the Abex/Intuitive headquarters in Madrid
Robotic surgery in head and neck oncology did not begin by chance, nor did it evolve following a generic roadmap designed for other surgical specialties. From the very beginning, it was shaped by the anatomical constraints of the upper aerodigestive tract where the natural minimally invasive access is transoral.
The Transoral Origin of Head and Neck Robotic Surgery
The application of robotics to head and neck surgery started with a clear and visionary concept (back in year 2004): use the new robotic system (the original da Vinci Standard) for a transoral access. This initiative was pioneered in Philadelphia by Gregory Weinstein and Bert O’Malley, who demonstrated that complex oncological resections of the oropharynx could be performed safely and effectively through the mouth using robotic assistance.
However, the da Vinci system was not designed with the oral cavity in mind. It was a multi-arm platform, optimized for large cavities such as the abdomen or pelvis. When adapted to transoral robotic surgery (TORS), a key compromise had to be made: one of the four robotic arms had to be sacrificed. Quite simply, it was impossible to introduce and maneuver four arms through the mouth simultaneously.
This limitation was not trivial. It defined how we worked, how we exposed tumors, and how we compensated manually or with bedside assistance. Yet, despite these constraints, TORS proved its value and opened a new chapter in head and neck surgery.
The Xi Era: Gains and Losses
With the arrival of the 4th generation, the da Vinci Xi, expectations were high. The system brought undeniable improvements: better boom architecture, easier docking, improved reach, and a smaller endoscope, which was particularly relevant in confined spaces such as the oropharynx.
But progress came with trade-offs. In head and neck surgery, we effectively lost the 5 mm instruments, which had been extremely useful in narrow fields. While the reduction in endoscope diameter was welcome, the lack of finer instruments limited precision in certain scenarios. Once again, the platform had evolved—but not specifically for us.
Waiting for the Single Port
For years, the head and neck community has been waiting for a system that truly matches our needs: a single-port robotic platform.
The rationale is obvious. Transoral surgery is, by definition, single-port surgery (the same logic applies to natural orifice approaches in general). A single port aligns naturally with this philosophy, allowing multiple instruments and the camera to enter through a single, controlled access point.
The da Vinci SP represents a major conceptual shift. Instead of adapting a multi-arm system to small spaces, it offers a design intended for confined anatomy. For transoral surgery, this is not just an advantage—it is a paradigm change.
Beyond Transoral: Remote Access Approaches
Interestingly, the benefits of single-port robotics extend beyond transoral surgery in HEad&Neck Robotic Surgery. Remote access approaches—such as transvestibualr, submental, retroauricular, areola or transaxillary routes—also involve restricted working spaces and long, narrow corridors.
In these settings, a single-port platform often makes surgical work simpler and more intuitive, although each approach has its own specific technical considerations that must be understood: the geometry, triangulation, and exposure strategies differ, and these nuances deserve detailed explanation on a case-by-case basis (learn more on remote access to the neck).
A Look Back: Medrobotics and Snake Robotics
Historically, it would be unfair not to mention Medrobotics and its “snake-like” robotic concept. It was an innovative and courageous attempt to address the limitations of rigid robotic platforms for transoral surgery.
However, in practical terms, only the endoscope was truly robotized. The instruments themselves were not, which limited dexterity and bimanual precision. While the system contributed valuable ideas and experience, it did not fully solve the problem of true robotic manipulation in confined spaces.
What’s Coming: Snake Robotics Revisited
More recently, platforms such as Shurui have generated interest. A single-port system incorporating snake-like robotic instruments is, at least conceptually, very promising for head and neck applications.
That said, we have not yet used this system clinically. We expect to do so soon, but until then, we cannot offer a meaningful opinion beyond acknowledging its potential. As always, real surgical experience—not specifications—will determine its value.
Are there other single-port systems on the horizon? Yes, several platforms are under development, reflecting a growing recognition that one size does not fit all in robotic surgery. Whether they will meet the specific demands of head and neck surgery remains to be seen.
Finally, Technology Is Catching Up
For the first time in many years, it feels like technology is moving toward the needs of head and neck robotic surgery, rather than the other way around. Single-port systems—especially those designed for natural orifice and confined-space surgery—represent a long-awaited alignment between surgical requirements and engineering solutions.
Yes, of course we want a single port for head and neck surgery.
Not as a luxury, but as a necessity.
J Granell. Jan 23, 2026