Posted: Jan 19, 2026
Updated: Feb 9, 2026
What is TORS?
Transoral Robotic Surgery (TORS) is a minimally invasive surgical technique that allows surgeons to operate on tumors and other conditions of the oral cavity, pharynx and larynx through the mouth, without external incisions. Using a robotic surgical system, the surgeon controls miniature articulated instruments and a high-definition 3D camera from a console, achieving a level of precision, stability, and visualization that is not possible with conventional transoral techniques.
TORS was specifically developed to address one of the main challenges in head and neck surgery: how to remove tumors located in the upper airway while preserving critical functions such as swallowing, speech, and breathing. By avoiding large open approaches (mandibulotomy, pharyngotomy), TORS represents a paradigm shift toward function-preserving cancer surgery through a minimally invasive approach.
Importantly, the robot does not act autonomously (not yet…). Every movement is fully controlled by the surgeon. The robotic platform translates the surgeon’s hand motions into precise movements inside the patient, filtering tremor and providing enhanced dexterity in confined anatomical spaces.
A Brief History: From Philadelphia to Global Adoption
The development of TORS is closely linked to the Department of Otorhinolaryngology–Head and Neck Surgery at the University of Pennsylvania (UPenn) in Philadelphia. In the early 2000s, Gregory Weinstein and Bert O’Malley explored whether robotic technology—already established in abdominal and urological surgery—could be safely adapted to transoral approaches in the head and neck.
After extensive laboratory work, cadaveric studies, and early clinical experience, the first human applications of TORS demonstrated that complex resections could be performed through the mouth with excellent oncologic exposure and functional outcomes.
A key milestone was reached in 2009, when the U.S. Food and Drug Administration (FDA) approved the use of the da Vinci robotic system for transoral procedures in the head and neck. This approval marked the transition of TORS from an experimental technique to a validated clinical approach, accelerating its international adoption and scientific evaluation.
Since then, TORS has become an integral part of modern head and neck oncologic surgery, supported by a growing body of evidence and incorporated into international treatment guidelines.
Main Indications of TORS
Although TORS can be applied to different pathologies, its most established and impactful indication is head and neck cancer, particularly:
- Oropharyngeal squamous cell carcinoma (tonsil, base of tongue)
- Selected supraglottic laryngeal cancers
- Early or well-selected tumors of the hypopharynx
Beyond oncology, TORS is also used in selected non-malignant conditions, such as:
- Obstructive sleep apnea (base of tongue reduction in carefully selected patients)
- Benign tumors of the upper aero-digestive tract and the para-pharyngeal space
Proper patient selection is essential. TORS is not suitable for all tumors, and decisions must be made within a multidisciplinary team, considering tumor size, location, extension, and patient-related factors.
How TORS Has Transformed Head and Neck Cancer Care
Before the advent of TORS, many oropharyngeal cancers required extensive open surgery or primary chemoradiotherapy. Both strategies could be effective oncologically, but often at the cost of significant long-term functional morbidity.
TORS has revolutionized the management of head and neck cancer in several key ways:
- Minimally invasive access: Tumors can be removed through the natural orifice of the mouth, avoiding facial scars and jaw splitting.
- Excellent visualization: High-definition 3D optics provide magnified views of critical anatomical structures.
- Precision and dexterity: Wristed robotic instruments allow fine dissection and accurate margin control.
- Functional preservation: Many patients experience faster recovery of swallowing and speech.
- De-intensification strategies: In selected patients, especially HPV-related oropharyngeal cancer, TORS can reduce the need for aggressive adjuvant treatments, lowering long-term toxicity.
As a result, TORS is now considered a cornerstone of modern, function-oriented oncologic surgery in the head and neck, and particularly for oropharyngeal cancer.
Current Technology: da Vinci Multiport and Single Port (SP)
At present, only Intuitive Surgical’s da Vinci robotic systems are clinically authorized for TORS:
- da Vinci multiport systems:Standard, S, and Si the original platforms used for the development and global expansion of TORS, and the ones originally approved by the FDA in 1999 but already discontinued, and the current Xi and X (4th generation).
- da Vinci Single Port (SP): a major technological evolution.
The da Vinci SP system represents a significant advance because it allows the introduction of a flexible 3D camera and three fully articulated instruments through a single transoral cannula, effectively enabling the use of four robotic elements through the mouth (TORS was originally described and later expanded with just three arms, as it is not possible to introduce the four arms of the multi-port system through the mouth). This design improves triangulation, simplifies setup, and expands access to deeper and more complex anatomical regions.
Currently, only the da Vinci multiport systems and the da Vinci SP have regulatory authorization for TORS in both Europe and the United States.
Looking Ahead: The Next Generation of Robotic Platforms
The future of TORS is closely linked to the development of new robotic concepts, particularly:
- Single-port and mono-channel systems
- Flexible or “snake-like” robotic architectures
Among emerging technologies, systems such as Shurui’s single-port robotic platform, based on continuum or snake robotics, illustrate the direction of innovation. These designs aim to further enhance flexibility, reduce invasiveness, and adapt even better to the complex anatomy of the upper aerodigestive tract.
While some of this these platforms are still under development or evaluation, they point toward a future in which TORS becomes even less invasive, more precise, and more widely accessible.
J Granell
Some References
Weinstein GS, O’Malley BW Jr, Snyder W, Sherman E, Quon H. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1220-6. doi: 10.1001/archotol.133.12.1220.
Moore EJ, Olsen SM, Laborde RR, García JJ, Walsh FJ, Price DL, Janus JR, Kasperbauer JL, Olsen KD. Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc. 2012 Mar;87(3):219-25. doi: 10.1016/j.mayocp.2011.10.007
Park YM, Choi EC, Kim SH, Koh YW. Recent progress of robotic head and neck surgery using a flexible single port robotic system. J Robot Surg. 2022 Apr;16(2):353-360. doi: 10.1007/s11701-021-01221-8.
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