title: Clinical applications of Telerobotic ENT-Head and Neck surgery.
abstract: OBJECTIVE
  To review the published clinical data in Telerobotic ENT-Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development.
  
  
  METHODS
  A qualitative review was performed of publications in PubMed, Medline and the Cochrane Database identified from the following keyword searches: Telerobotic/Robotic ENT, Otorhinolaryngology, Head and Neck surgery, Thyroid and Parathyroid surgery. Preclinical studies and non-clinical review articles were excluded.
  
  
  RESULTS
  Forty-five publications were identified including 7 review articles. Transoral robotic surgery (TORS) was reported in 20 clinical studies, robotic-assisted thyroidectomy in 13 studies, parathyroidectomy in 4 studies and skull base surgery in 1 study. The majority of TORS publications relate to oropharyngeal malignancy which were Stage III and IV. Clinical benefits include avoidance or dose reduction of adjuvant chemoradiotherapy and improved swallow function. The primary clinical advantage of robotic-assisted neck surgery is the avoidance of a neck scar. The learning curve for robotic thyroidectomy is 50 cases. Body habitus is an important factor for assessment of robotic feasibility in transoral and neck surgery.
  
  
  CONCLUSIONS
  The application of robotic-assisted parathyroidectomy, thyroidectomy and TORS suggests promising improvements in patient care. Randomised control trials are needed to assess clinical outcome, cost effectiveness and patient benefit in the existing applications. Continued development of robotic technology will expand the viable clinical applications in this specialty.
authors.affiliation: Departments of ENT, Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London W2 1NY, UK. asitarora@doctors.org.uk
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.forename: Aileen
authors.initials: A
authors.lastname: Cunningham
authors.forename: Gaurav
authors.initials: G
authors.lastname: Chawdhary
authors.forename: Claudio
authors.initials: C
authors.lastname: Vicini
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Neil
authors.initials: N
authors.lastname: Tolley
mesh_terms: D006257:Head / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D009333:Neck / Q000601:surgery; D010038:Otorhinolaryngologic Diseases / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D016105:Parathyroidectomy / Q000379:methods*; D012371:Robotics; D013965:Thyroidectomy / Q000379:methods*