Source: www.cancernetwork.com Author: Amy Y. Chen, MD, MPH, FACS This paper by Drs. Bhayani, Holsinger, and Lai describes a new approach to an old problem. Advances in the management of head and neck cancer over the past few decades have been made predominantly in the area of non-surgical therapy. Starting with the Veterans Affairs Cooperative Trial for laryngeal cancer in the early 1990’s,[1] advances in the administration of chemotherapy and radiation therapy have enabled patients to forego traditional extensive resections that compromised speech and swallowing function.[2] The advances in combined chemoradiation for advanced head and neck cancer have come with a detriment to some patients in survival and quality of life.[3] Effective treatment, but with decreased morbidity was needed. Robotic surgery is one treatment that, in combination with chemotherapy and radiation, as needed, is yielding comparable oncologic outcomes while preserving speech and swallowing function. The authors detail the history of robotic surgery well. In short, the current daVinci system functions as a master-slave robot, with the surgeon manipulating instruments connected by a cable network to the robotic cart. Three arms exist (one for the camera and two accommodate 8mm and 5mm instruments). The camera enables not only magnification but also three dimensional viewing of the surgical field. The advantage of using robotic arms is the ability to reach locations that were previously not reachable without a mandibulotomy and/ or pharyngotomy. Stage III and IV cancers of the head and neck consist of primary tumors of all sizes. The major determinant [...]