Institutional evolution of a robotic otolaryngology program across consecutive da Vinci Si, Xi, and SP platform...

Sustained development of a robotic otolaryngology program depends on coordinated technological, workforce, clinical, and educational development. However, how these elements evolve together over time remains poorly understood. We conducted a retrospective longitudinal program evaluation of 757 consecutive robot-assisted otolaryngology-head and neck procedures performed at a regional teaching hospital from 2013 to 2025. Annual volume increased from 10 procedures in 2013 to a peak of 122 in 2022 and remained high at 95 in 2025, showing a strong correlation with calendar year (Spearman's ρ = 0.923, p < 0.001). Negative binomial regression estimated an average annual increase of 21.5% (incidence rate ratio 1.215, 95% confidence interval 1.157-1.276). The program progressed from the da Vinci Si to Xi and single-port platforms, with the single-port system accounting for 52 of 95 procedures (54.7%) in its first year of deployment. The workforce expanded from one to five surgeons; the founding surgeon performed 531 procedures (70.1%), while four recruited surgeons performed 226 (29.9%). Clinical scope encompassed oral cancer, radical tonsillectomy, sleep surgery, benign and malignant tongue-base resections, parotidectomy, thyroid surgery, supraglottic laryngectomy, hypopharyngectomy, and other head and neck procedures, with distributions differing significantly across the three phases (χ² = 253.43, Monte Carlo p < 0.001; Cramér's V = 0.409). Structured multidisciplinary training and observation activities accompanied clinical growth and the program's development into a regional educational hub. This 13-year experience demonstrates the transformation of a single-surgeon service into a multisurgeon regional clinical and educational program across successive platform transitions.