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Updated: Jan 10, 2026
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Learning process of transoral robotic surgery for head and neck cancers: a scoping review
1Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology, Elsan Hospital, Poitiers, France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
Background:
The learning curve for Transoral Robotic Surgery (TORS) in head and neck cancer (HNC) management remains incompletely characterized despite its increasing adoption. This systematic review evaluated the learning curves and required case volume for achieving proficiency and identified factors influencing the learning process.
Methods:
Two investigators conducted a PubMed, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, oncological and learning curve outcomes related to the implementation of TORS in HNC surgery using the PRISMA statement. The bias analysis was conducted with the MINORS.
Results:
Of the 102 identified studies, 9 studies met our inclusion criteria, including 792 (82.1 %) male patients. TORS learning curve was primarily investigated on cT2N1 oropharyngeal cancer. The number of requested cases to achieve inflexion point in performing TORS varied by outcome measures but globally ranges from 25 to 50 cases. The mean MINORS was 8.8 ± 1.8 There was substantial heterogeneity across studies for the definition and criteria used to determine the learning process/inflexion point. No study detailed the surgeon experience and features. Two studies described the training program applied to surgeons before starting the study.
Conclusion:
TORS proficiency case numbers remain unclear due to study heterogeneity, non-standardized endpoints, and variable definitions. Estimates range 20-50 cases for operative outcomes; long-term results require higher volumes. Future prospective studies are needed to standardize learning definitions and analyze how surgeon-specific factors (experience, age, prior training) impact TORS learning curves.
