Transoral Robotic Surgery (TORS) for supraglottic laryngectomy was the original vision behind the development of TORS by Greg Weinstein and Bert O’Malley more than twenty years ago. The idea was to achieve a precise oncologic resection through a minimally invasive approach that was more reproducible than Transoral Laser Microsurgery for complex cases.
Recently, I have performed two comprehensive TORS supraglottic laryngectomies (and I am currently preparing a book chapter on TORS for laryngeal cancer). I would like to share some reflections on the topic.
The tumors were similar, the indications comparable, and the surgical plan essentially identical. Yet the experiences could not have been more different. In the first case, console time was 31 minutes, margins were satisfactory, and bilateral neck dissection was completed immediately afterwards. The second case was a surgical nightmare and what should have been a straightforward procedure occupied the entire morning (neck surgery had to be staged for another day). Same operation. Similar tumors. Completely different experiences.
This highlights one of the realities of TORS for laryngeal cancer: a significant degree of unpredictability remains. Some of the reasons are well understood: anatomy, exposure, patient factors, and instrumentation limitations; others are still difficult to explain.
Twenty years after the birth of TORS, we continue to need technological improvements. Single-port systems may help. Snake robotics may help. Perhaps another tech breakthrough is around the corner. Whatever form it takes, better access, visualization, and instrument maneuverability are still needed if we want to make these procedures more reproducible.
We will continue discussing TORS for laryngeal cancer. For now, the key message is simple: despite remarkable progress, transoral robotic supraglottic laryngectomy remains a procedure where excellence and unpredictability can coexist in consecutive cases.
We must keep pushing the technology forward. Our patients demand it.
J Granell. Jun 20, 2026
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