Innovation, cost, and evidence: a critical appraisal of robotic surgery in head and neck and endocrine surgery : A structured critical review of the evidence, with attention to lower-resource settings.

Authors

Jay Dave, Renu Rajguru, Swarnava Chanda, Rosy Saikia, Rachit Sood

Published in

Journal of robotic surgery. Volume 20. Issue 1. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

Robotic platforms have expanded rapidly across head and neck and endocrine surgery - from transoral robotic surgery (TORS) for oropharyngeal cancer to remote-access thyroid and parathyroid approaches - often driven by patient demand, hospital branding, and industry marketing rather than by evidence, with particular equity implications in lower- and middle-income countries (LMICs). We conducted a structured critical review of the highest-level available evidence, identified from PubMed/MEDLINE and the Cochrane Library and by reference-list hand-searching up to mid-2026, prioritising randomised controlled trials, systematic reviews and meta-analyses, large cohort studies, health-economic analyses, and multisociety consensus statements. Because the clinical questions span oncologic, functional, economic, and health-systems domains, evidence was synthesised narratively and graded by level within each domain. Across indications, robotic surgery demonstrates outcomes equivalent to - not superior to - conventional surgery. Level I randomised evidence exists for oropharyngeal TORS, whereas robotic thyroidectomy and parathyroidectomy rest on observational series subject to selection bias. The principal demonstrated benefits are cosmetic for remote-access thyroidectomy and avoidance of open access for selected TORS. Formal cost-effectiveness analysis shows robotic approaches frequently exceed accepted willingness-to-pay thresholds, especially in LMICs, where robot-free alternatives such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) are relevant. A four-pillar value-based framework - oncologic outcomes, functional outcomes, patient-reported outcomes, and cost-effectiveness - supports selective, transparent, case-by-case adoption rather than uncritical uptake.

PMID:
42640389
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

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