1 Unlike other head and neck malignancies, the incidence has not decreased in association with the decreasing prevalence of one of the major risk factors, cigarette

smoking. This discrepancy has been attributed to the increasing proportion of oropharyngeal cancers which are related to human papillomavirus (HPV) infection. These HPV-related tumors occur in younger patients, are more likely to occur in never-smokers and never-drinkers, and have better survival rates than HPV-negative tumors.2,3 Management of oropharyngeal cancers generally involves a combination of surgery, radiation, Inhibitors,research,lifescience,medical and chemotherapy. Historically, locally advanced cancers of the tonsils and tongue base have been difficult to visualize from a transoral viewpoint and required extensive Inhibitors,research,lifescience,medical tissue dissections from an open approach or were treated predominantly with chemotherapy or radiation. The introduction of transoral robotic surgery (TORS) has allowed an increase in the ability to manage oropharyngeal cancer via primary minimally invasive surgery.4 In the context of a rising number of HPV-related cancers, TORS is an increasingly GSK1120212 mouse important tool in the approach to management of oropharyngeal cancer. In this article, we review the role of transoral robotic surgery

(TORS) in the management of oropharyngeal cancers, and specifically Inhibitors,research,lifescience,medical how this minimally invasive technique will affect the management of HPV-related tumors. HISTORICAL PERSPECTIVES While robotic technology has been routinely used for industrial purposes for over 60 years, it was not until relatively

recently that it was introduced to the field of surgery. The first reported employment of Inhibitors,research,lifescience,medical a surgical robot was in 1985 when the PUMA 560 robot was used by a group of neurosurgeons in California to improve the accuracy of CT-guided stereotactic biopsies.5 Urologists were not far behind, and within 6 years the same PUMA 560 was used Inhibitors,research,lifescience,medical to perform the first minimally invasive robotic procedure during a transurethral resection of the prostate.6 From there, robot-assisted procedures continued to develop and became popular in a number of other specialties including gynecologic, cardiothoracic, orthopedic, and general surgery. In spite of its growing popularity, application of this new technology by otolaryngologists was initially quite limited. The early instruments were designed for use in spacious cavities, such as the abdomen or pelvis, with widely spaced Methisazone access ports. They were bulky and not well-designed for the anatomic constraints of the head and neck. However, as robot technology continued to adapt for use in surgery and newer instruments were developed, head and neck surgeons began developing transoral robotic surgery (TORS).7 In 2005, McLeod and Melder performed the first transoral robotic-assisted procedure when they used the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to excise a vallecular cyst.8 During that same time, O’Malley et al.