and some other historical facts around it
In 2015, Greg Weinstein and Bert O’Malley were kind enough to write the preface to the first book on robotic surgery that Raimundo Gutierrez and I edited. Beyond being a great honor for us personally, that preface contained something more valuable: a very personal account of the origins of Transoral Robotic Surgery and several historical details surrounding its development, including the story of how the name “TORS” was chosen.
The preface has been reproduced in several of our subsequent books and is now available online from multiple sources. But one paragraph from Greg’s original document remains especially fascinating:
It was in this milieu of limited primary surgical options and devastating chemoradiation that one of our Penn residents Neil Hockstein, began his senior research project with a trip to Intuitive Surgical, Inc, in Sunnyvale, California. With Department leadership and resource support for this innovative project he arrived in California with a satchel filled with various mouth retractors and a goal of determining how the multiple arms of the da Vinci system might best be passed and then manipulated transorally. Dr Hockstein’s work and early publications made a major contribution to the evolution of TORS as he succeeded in showing that three arm robotic access and manipulation was possible using a common mouth retractor, such as the Crowe Davis. This research project established the foundation for developing a series of surgical procedures in what our team at Penn coined the name TORS.
It is the use of a minimum of three robotic arms inserted transorally that allowed the next level of innovation to occur. We toyed with another acronym, namely Computer Enhanced Robotic Transoral Surgery (CERTS) but we were concerned that the name may infringe upon the trademark of a popular breath mint in the United States. We also decided that TORS sounded more powerful, like the hammer wielding Norse god, Thor. We soon realized that seemingly small details such as a name or acronym can impact long term adoption
Funny, “CERTS” was an instantly recognizable commercial name. It was a very well-known American breath mint and candy brand introduced in the late 1950s. So beyond the possible trademark issues, there was a risk of not being taken seriously…
“Computer Enhanced” reflects how robotic surgery was perceived in the early 2000s: not as autonomous robotics, but as computer-mediated enhancement of the surgeon’s movements. In fact, early da Vinci literature frequently described the platform as a “computer-enhanced surgical system” rather than a robot (which is for certain technically more accurate than “robotic surgery”, for now).
Notice that this paragraph contains not only the origin of the name, but also an actual definition of the technique itself. TORS was defined by the introduction of the endoscope together with at least two instrument arms through the transoral route. This was obviously intended, at least in part, to distinguish the concept from the previous robotic experience described by McLeod&Melder, but the logic behind the definition remains sound even today. We are now moving toward single-port robotic transoral surgery platforms, using three instrument arms (and the endoscope) through a single cannula. The conceptual definition established in those early Penn years still applies in these circumstances.
The text also highlights that TORS was fundamentally an exposure problem (is is still today in many clinical circumstances). The initial breakthrough was not simply “putting a robot through the mouth.” It was understanding how to achieve stable transoral exposure while allowing simultaneous introduction and triangulation of multiple robotic arms. That was the true enabling step.
And that problem of exposure continued driving innovation afterward. Later, the Penn group developed the FKWO pharyngolaryngoscope. The device itself evolved from a previous retractor designed for amplified transoral exposure for laser surgery. FKWO stands for Feyh, Kastenbauer (the German ENT surgeons involved in the original concept and design lineage of the device), Weinstein, O’Malley (who modified and adapted it specifically for TORS applications). So, the device upon which we have built much of the scientific evidence supporting TORS is not the “FK” retractor many people casually refer to, but the FKWO.
And remember, from the very beginning, the search for new instruments, new retractors, and new robotic approaches, like TORS, was never about technology for its own sake. It was always about evolving and solving problems in order to provide better patient care.
J Granell. May 17, 2026
