[Transoral robotic total laryngectomy and neck dissection: the concept of robotic combo surgery]

The classic indications of TORS are still limited mostly to partial resections of the oropharynx, hypopharynx und supraglottic larnyx. In addition to these, there has been some promising applications towards broadening the limits of robotic assisted head and neck surgery and to perform a trans oral total laryngectomy (TORTL). Using the robotic assisted transoral approach for a total laryngectomy can reduce the risk of fistula formation after salvage laryngectomy effectively, avoiding a wide apron flap and with no plane dissected between the skin and the strap muscles. Trans Axillary Robotic Surgery, or TARS, offers similar advantages through an axillary access to the outer neck: this way, the skin incision will be placed outside of the future radiation field, if the latter is indicated. The transaxillary thyroidectomy is an important step in the learning curve of robotic assisted neck dissection and other TARS-procedures, and is seen as "the gateway to the neck". The present review article provides with a summary of the published literature of this novel approach to date, i. e., transoral robotic total laryngectomy and robotic assisted neck dissection. The fusion of these 2 adds up to the concept of Robotic Combo Surgery, resulting in the ultimate combination of scarless head and neck surgery for the primary as well as for the neck.