Transoral robotic surgery using the da Vinci single-port system: current evidence and clinical indications - a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcomes

• Effect Size: Console time 60.04 minutes, operative time 57.72 minutes

• Primary Outcome: Feasibility and safety of SP TORS across clinical indications

• Nnt Or Sensitivity: No intraoperative conversions to multiport or open surgery reported across all studies

• Confidence Interval: Console time 95% CI 29.56-90.51 minutes

Clinical Application

Limited by technology availability, surgeon training requirements, and cost considerations Technology availability through private hospitals and major public centres; TGA approval status unclear; not currently PBS-funded; RACS training requirements would need development Highly selected patients in specialized robotic surgery centres with appropriate case volume and expertise

Abstract

The DaVinci Single-Port (SP) transoral robotic surgery (TORS) platform was developed to overcome spatial constraints and instrument collisions encountered with multiport systems in head and neck surgery. We systematically reviewed and meta-analyzed perioperative performance, safety, functional recovery, and oncologic outcomes of SP TORS. Following PRISMA 2020, we searched PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and the first 25 pages of Google Scholar through January 1, 2026. Peer-reviewed English-language clinical and cadaveric studies evaluating SP TORS were included. Three reviewers screened studies and extracted data. Random-effects meta-analyses were performed where appropriate. Fourteen studies (2019-2025) including 479 patients met inclusion criteria. Patient-level evidence was concentrated in oncologic cohorts, with additional smaller clinical applications in obstructive sleep apnoea-related tongue-base surgery (37 patients), hypopharyngeal foreign body removal (1 patient), parapharyngeal space surgery (2 patients), and SP-assisted reconstruction (3 patients), as well as preclinical feasibility studies. No study reported intraoperative conversion to multiport or open surgery. Pooled estimates were console time 60.04 min (95% CI 29.56-90.51; I² = 99.1%), docking time 10.13 min (0.47-19.79; I² = 97.9%), operative time 57.72 min (37.23-78.21; I² = 0.0%), length of stay 10.63 days (2.43-18.82; I² = 99.8%), and blood loss 24.16 mL (- 6.95 to 55.27; I² = 86.8%). Bleeding was the most consistently reported surgical complication, with major bleeding requiring operative management reported in larger cohorts but remaining uncommon. Functional recovery suggested early oral intake, although timing was inconsistently reported. Margin status was predominantly R0 in several oncologic cohorts, although one matched cohort reported a lower R0 rate. SP TORS appears feasible across indications, but current evidence is limited by nonrandomized designs, inconsistent long-term reporting, and between-study heterogeneity.

References

1. 1.Niederegger, T., Karakas, E., Satea, M., Hoch, C. C., Hundeshagen, G., Knoedler, L., Metzger, M.-C., & Wüster, J. (2026). Transoral robotic surgery using the da Vinci single-port system: current evidence and clinical indications - a systematic review and meta-analysis. Journal of Robotic Surgery. https://doi.org/10.1016/j.ejca.2025.115343