1 – Description: Transoral Robotic Surgery (TORS) represents a transformative advancement in the surgical management of T1–T3 hypopharyngeal cancers and glottic cancers involving the anterior commissure—tumors traditionally considered to have poor prognoses and located at complex anatomical locations. This robotic-assisted technique features a high-magnified 3-D endoscope and endo-wristed instruments with motion scaling and tremor reduction capabilities. These technological advantages enable surgeons to perform precise, minimally invasive resections while preserving critical structures and organ function. In cases of recurrent laryngeal cancer requiring total laryngectomy, TORS may be applied to minimize trauma to cervical skin and mucosal surfaces of the upper digestive tract, thereby reducing postoperative complications. This session will present over a decade of clinical experience using TORS in combination with neck dissection, emphasizing its role in accurate pathological staging, long-term oncologic control, and functional outcomes. The potential for adjuvant therapy de-intensification based on surgical findings will also be discussed. Special focus will be given to patient selection, surgical strategy, the role of neoadjuvant therapy, and innovative procedures such as TORS supra-cricoid partial laryngectomy with thyroid cartilage preservation and minimally invasive total laryngectomy. Drawing from long-term follow-up data, this presentation will demonstrate how TORS offers not only functional preservation but also potential survival benefits for appropriately selected patients.

2 – Outcome Objectives: -Understand innovative techniques of TORS and criteria for optimal patient selection.

-Learn how TORS enables accurate pathological staging and informs adjuvant therapy planning.

-Recognize key prognostic factors affecting oncologic outcomes, including pathological N stage and extranodal extension (ENE) in hypopharyngeal cancer.

-Appreciate long-term survival rates and functional outcomes following TORS for hypopharyngeal and glottic cancers involving the anterior commissure.

-Explore the potential role of neoadjuvant therapy in enhancing outcomes prior to TORS.

3 – Structure of the Session: The keynote speaker will share over 10 years of experience in transoral robotic surgery (TORS) for hypopharyngeal and laryngeal cancers. He will present innovative surgical techniques through operative videos and discuss long-term outcomes based on his peer-reviewed publications, along with the latest unpublished data available prior to the congress. The session will conclude with a 5-minute Q&A to encourage audience engagement.

4 – Background (Selected Key References):

References

1. Chen-Chi Wang el al. Trans-oral robotic surgery for early T-classification hypopharyngeal cancer. Head Neck. 2016 Jun;38(6):857-62

2. Chen-Chi Wang el al. Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers-A prospective Medium-Term Study. Journal of Clinical Medicine Mar 2;10(5):967

3. Chen-Chi Wang el al. Transoral Robotic Surgery for Early-T Stage Glottic Cancer Involving the Anterior Commissure—News and Update. Front Oncol. 2022 Jan 31;12:755400. doi: 10.3389/fonc.2022.755400. eCollection 2022

4. Chen-Chi Wang el al. Long-term Outcomes of Trans-Oral Robotic Surgery-Assisted Total Laryngectomy for Recurrent Laryngeal Cancers. Jpn J Clin Oncol. 2020 Jun 10; 50(6): 653-660

5. Chen-Chi Wang el al. Transoral robotic surgery for early glottic carcinoma involving anterior commissure. Head Neck. 2016 Jun;38(6):913-8.

Despite the widespread adoption of transoral robotic surgery (TORS) in oropharyngeal

cancer, several aspects of surgical strategy remain highly controversial. This round table

will focus on four hot topics that continue to challenge clinical practice: (1) the role of

radiological assessment in surgical planning, with particular attention to whether styloid

process involvement should be considered a contraindication; (2) the debate over margin

adequacy and how oncological safety should be redefined in the HPV-positive era; (3)

the relationship between perioperative bleeding and reconstructive techniques; and (4) the

potential role of neoadjuvant chemotherapy in patient selection and outcomes. Each

controversy will be addressed by expert panelists through short, case-based presentations

followed by open discussion with the audience. The session aims to provide practical

insights, highlight unresolved questions, and foster a multidisciplinary exchange to

optimize surgical decision-making in oropharyngeal TORS.

Eighty-five percent of nasopharyngeal carcinoma (NPC) cases present with lymphadenopathy, most commonly involving level II cervical lymph nodes and the retropharyngeal space. The surgical management of recurrent lymph node (LN) metastases in the retropharyngeal space is particularly challenging due to the complexity of the anatomy and the destructive nature of traditional open surgical approaches, such as maxillary or mandibular swing techniques. With the advent of the da Vinci surgical robot, transoral robotic surgery (TORS) has been adopted as a minimally invasive approach to remove retropharyngeal LN metastases. In this program, we will demonstrate the use of the da Vinci Xi system to excise retropharyngeal lymph nodes using three instruments: Maryland Bipolar Forceps, Monopolar Curved Scissors, and ProGrasp Forceps. Enhanced traction and countertraction provided by the ProGrasp Forceps, combined with the assistance of a bedside surgeon, enable safe and precise dissection of the retropharyngeal LN. The procedure ensures effective hemostasis and benefits from high-magnification, interchangeable 30-degree upward or downward 3D endoscopy. Additionally, the tremor reduction and motion filtration features of the da Vinci Xi system allow a robotic surgeon with 15 years of experience to perform complex two-surgeon, four-handed procedures in a confined space with greater dexterity and precision. (Video link https://zenodo.org/records/15537792 )