Robotic soft-tissue surgery was never conceived to replace procedures that are already simple, fast, and safe. It was born to solve problems: to facilitate access, and in some cases to make surgery possible, in anatomical regions where minimally invasive approaches were previously unfeasible or particularly complex.
As soon as the technology became available, surgeons quite naturally began to explore what else it could do. That exploratory phase is necessary, and still goes on (also shaping technology). Along the way, robotic surgery produced an important secondary effect: it helped democratize minimally invasive surgery by lowering the technical barrier of highly complex procedures and making them accessible to a broader surgical community (this is a sensitive issue to be discussed in another post).
Today, the direction seems almost inevitable. We are progressively robotizing every surgical procedure that was previously performed endoscopically. That will happen. Inevitably. But there is a critical variable we must not ignore, and that variable is time. Not operative time—historical time.
The real question is not whether something can be robotized, but when it should be.
Since I began teaching robotic surgery more than a decade ago, my position has been consistent and very public: a conventional palatine tonsillectomy for benign disease should not be performed using the da Vinci system. Not because it is forbidden. Not because it is unsafe per se. But because it is unjustified.
The arguments usually put forward to defend this practice are always the same. One is that tonsillectomy is a highly standardized and simple procedure, supposedly ideal for getting familiar with the robot. The other is purely logistical: filling allocated robotic operating room time so as not to lose it when there are no robotic indications scheduled. Neither argument withstands serious analysis.
A conventional tonsillectomy is a 15-minute operation for any ENT surgeon, including residents. By robotizing it, we inevitably prolong surgical time, introduce additional instrumentation, and increase procedural complexity, without delivering any tangible benefit to the patient. From a cost perspective, the equation is indefensible; there is simply no way to justify the additional expense in exchange for zero clinical gain.
This is not how a learning curve should be built.
Training is not a blank check to misuse technology. Using robotic tonsillectomy as a surrogate training exercise offers, at best, marginal transfer to oncologic transoral robotic surgery. The anatomy, objectives, tissue handling, and hemostatic demands are fundamentally different. That is precisely why structured robotic curricula, simulation platforms, and virtual training environments exist. That is where learning belongs.
Anyone who has actually tried it knows the reality. You grasp the tonsil with a Maryland and it tears. Hemostasis becomes more difficult, not easier, even if you have performed hundreds or thousands of conventional tonsillectomies. The ergonomics feel awkward, the feedback is poor, and by the end of the case you have not acquired a skill that meaningfully translates to complex transoral oncologic surgery.
But the most serious consequence is neither technical nor economic.
It is reputational.
Within the hospital (and outside), these decisions are noticed. They shape how a Department is perceived by colleagues, administrators, and leadership.
Years ago, I came across a doctoral thesis produced during the very early days of surgical robotics, from one of the first hospitals in my country to acquire a da Vinci system. The work focused on robotic cholecystectomy, at a time when robotic surgery was exceptional, scarce, and already clearly pointing toward transformative applications elsewhere. That thesis did not demonstrate innovation. It documented a failure of vision. It reflected poorly not only on the surgical unit involved, but also on the institutional leadership of the time; custodians of a powerful tool who neither understood where it mattered nor how to use it responsibly.
Robotic conventional palatine tonsillectomy for benign disease sends a similar signal today.
And if you truly believe you want to use the robot for an unusual or unconventional indication, there is a correct path. Write a Research Protocol. Define a meaningful hypothesis. Submit it to your institutional review board or ethics committee. Obtain approval. Proceed transparently. I am sure no ethics committee would approve robotic surgery for conventional tonsillectomy under those conditions, and that, in itself, should give us pause.
Robotic surgery is one of the most powerful tools we have ever incorporated into Head&Neck Surgery. Used wisely, it expands boundaries, reduces morbidity, and enables procedures that were once unthinkable. But technology does not justify itself by mere availability.
When a robot is used not because the patient benefits, but because the schedule demands it, the learning curve needs it, or the machine is there, we have lost the plot.
J Granell. Feb 9, 2026
Next post:
How the da Vinci helped democratize Minimally Invasive Surgery Feb 14, 2026