Since Malley et al [1] successfully applied robot-assisted surgery to the resection of tongue root tumor in 2006, robot-assisted surgery has been used in the surgical treatment of various head and neck tumors and repair and reconstruction in clinical practice one after another. In this paper, we review and summarize its development and recent applications in head and neck tumor surgical treatment, and discuss its clinical application value and prospect in this specialty. The first robot-assisted surgical system was a stereotactic device (Puma) invented by the California Center for Radiology in 1985, and they applied it to complete the first human-controlled robot-assisted precise positioning of brain tissue biopsy [2]. After more than 20 years of development, robotic-assisted surgery is now developing rapidly in some developed countries such as the United States and Europe, with a total of 1400 Da Vinci robotic surgical systems (Da Vinci SuRobot) in the United States in 2009, a number that has increased by 75% compared to 2007 [3]. The robotic surgical system consists of three main components (a master console operated by the surgeon, a mobile platform consisting of a robotic arm, a camera arm and surgical instruments, and a video imaging platform for 3D imaging). Although the operation is performed through the same path into the body as endoscopic surgery, the robot is significantly better than conventional endoscopic surgery in terms of precision and flexibility of surgical operations. When endoscopic surgery is performed with the human hand, the surgeon’s hand is limited to four degrees of freedom (up and down, left and right, rotation along the long axis of the instrument, and opening and closing of the end of the instrument), which reduces the dexterity of the surgeon’s hand, while viewing two-dimensional images and controlling the camera by an assistant causes the surgeon to lose a sense of visual depth and intuitive smooth control of the operative field, weakening the function of the surgeon’s eye and reducing the coordination between the hand and eye. These increase the difficulty of performing basic operations such as suturing and separation [3]. In addition, involuntary hand tremor and reduced tactile sensation also increase the difficulty of endoscopic surgery, which hinder the further development of minimally invasive surgery. The da Vinci surgical operating system developed by Intuitive Surgical, a mainstream product in the market, can perform precise surgical operations (positioning, grasping and cutting, etc.) in seven degrees of freedom by means of three operating arms and one camera arm [4]. The operator can control two of the three to four manipulator arms and switch them at any time, which can simulate the movements of the human hand, and the movements of the hand to the head end of the instrument are visible and have a sense of space, which can make the surgeon feel like his hand is inside the patient during surgery. Second, the development of robot-assisted surgery in head and neck surgery head and neck due to the proximity of important anatomical structures, surgical operation space is limited and other factors, the development and application of robot-assisted surgery than thoracic and abdominal surgery treatment relatively lagging behind. Robotic surgery in the field of otolaryngology-head and neck surgery was first reported in 1995 by Brett et al [5], who mainly used the precision of robot-assisted surgery for some simple surgical operations such as stapedial pedicle foraminotomy, etc. In 2005, Haus et al [6] from Stanford University conducted the first comprehensive systematic animal experiments, in which they used pigs as animal models to perform 32 surgical procedures respectively. Robotic-assisted surgical treatment included submandibular gland resection, selective neck clearance, partial parotidectomy, and thymectomy. In 2006, Malley et al [1] performed a series of animal experiments and surgical simulations on cadavers, which led to a true clinical practice of robotic-assisted head and neck tumor surgery. Intraoperatively, the lingual root tumor was excised completely with negative margins, good bleeding control and no postoperative complications. In 2009, the Food andAdministration (FDA) approved the first robotic surgical operating system for head and neck surgery. “Da Vinci Transoral Surgical Robot (Intuitive Surgical Inc, Sunnyvale, SA), which was successfully used in the clinical treatment of patients with oropharyngeal cancer in the same year [7]. Since then, this surgical system has been reported to be used for radical resection and lymph node dissection of various types of head and neck tumors, as well as for post-tumor resection repair and reconstruction. At present, robot-assisted surgical treatment of head and neck tumors mainly includes the following three aspects: ① transoral robotic head and necksurgery (TORS) for resection of tumors in the larynx, oral cavity, oropharynx and skull base, which is mainly suitable for tumors that are not very large (T3 or less). This approach is mainly suitable for tumors that are not very large (T3 or below) and the junction between the tumor and normal tissue can be clearly shown by the display. (2) Additional cervicothoracic approach for thyroid and parathyroidectomy, neck clearance, etc. This approach is mainly suitable for unilateral adenomectomy and elective neck clearance. (3) Preparation and suture fixation of flaps in the repair and reconstruction of head and neck defects. This approach is mainly adapted to the preparation of muscle flaps such as latissimus dorsi and pectoralis major, which can be easily operated in the cavity, and the suturing of flaps in the oropharyngeal cavity to reduce surgical trauma. In addition, robotic surgery has been tried for salvage surgery of recurrent tumors, etc. Malley et al [1] performed TORS approach for lingual root cancer resection in 2006, which was the first robotic-assisted clinical treatment of head and neck tumor surgery. In this study, they used a robotic system to perform surgical resection of two patients with lingual root cancer, which made it easier for the operator to identify and protect the linguopharynx, sublingual and lingual nerves and lingual artery and other related structures. The surgical results were satisfactory in terms of minimally invasive and tumor resection, and there were no postoperative complications associated with the surgery. The following year Solares and Strome [8] performed a successful TORS-assisted carbon dioxide laser treatment of a 74-year-old patient with supraglottic laryngeal cancer. The combination of the two techniques greatly improved the visibility and operability of the procedure and made it more precise and minimally invasive. In addition to assisting in the resection of the primary focus, robotic surgery can also play a role in the one-stage repair and reconstruction of flaps Mukhija et al [9] reported the use of a robot to complete the coverage and suture fixation of defects in the oropharyngeal cavity with free forearm flaps in two patients with oropharyngeal and oral cancer. The preparation time was about 10 min, and the entire operation (including primary resection and repair) took less than 4 h. The use of robotic assistance made it possible to avoid mandibular and tracheal dissection, and the patients recovered well from postoperative feeding and speech, and had an aesthetically pleasing face, and were discharged from the hospital 3 d earlier than conventional surgery, with satisfactory recent outcomes. For the evaluation of long-term efficacy, there is a lack of reports on the 5-year survival rate and local recurrence rate of TORS.Weinstein et al [10] found that the regional control rate could reach 96% and the control rate of distant metastases reached 91% after robotic-assisted surgery in a group of patients with advanced oropharyngeal cancer at 18 months of postoperative follow-up. After the successful clinical application of TORS technique in oropharynx and larynx, Malley et al [11] applied it to the first case of parapharyngeal tumor invading the inferior temporal recess in 2007 after animal experiments and cadaveric surgical simulation, and the robotic surgery helped to identify and protect important structures such as intracarotid arteries and cranial nerves at the base of the skull, and no surgery-related complications such as hematoma and cranial nerve injury occurred. In contrast to TORS, robotic surgery in neck tumor applications requires additional incisions and re-establishment of surgical tracts to access the lesion with aesthetic results. In this regard, there are many studies on thyroid tumors, where axillary or areolar incisions are often used for aesthetic purposes, and robotic surgery has the advantages of aesthetics, fewer postoperative complications, and minimal subjective postoperative symptoms compared to conventional surgery [12]. 2011 Lee et al [13] reported a multicenter study of 1043 patients, and they found that robotic surgery was more effective than conventional open surgery in terms of They found that robotic surgery did not differ significantly from conventional open surgery in terms of safety, operability, and efficacy, while patients had significantly better outcomes in terms of postoperative complications and aesthetics. Similar to thyroid surgery approach and surgical technique, in 2004 Bodner et al [14] reported the first robot-assisted parathyroidectomy. A 5- to 6-cm vertical incision was made subcutaneously in the axilla and three robotic arms were placed to form an axillary to anterior cervical surgical approach through the pectoralis major muscle and clavicle. In addition, an additional 0.8-cm incision was made in the anterior chest and a robotic arm for traction building was placed to form the operative space. Through these two incisions, four arms can precisely perform surgical retraction, separation and cutting. In addition to the application of robotic neck surgery in thyroid surgery, its value in cervical lymph node dissection has been recently explored. lee et al [15] performed cervical dissection on the scaphohilar hyoid bone in 26 patients with cN0 oral cancer through a facial debridement incision or an additional incision behind the ear with robotic assistance. The results showed that although robot-assisted surgery had a longer operative time [(157±22) min compared to (78±16) min] compared to conventional open surgery, no statistically significant differences were found between the two groups in terms of efficacy, length of stay and complication rates of neck clearance. After subjective assessment of patients in terms of postoperative aesthetics, the robotic surgery group was significantly better than the conventional treatment group, with the surgical incision concealed behind the ear and within the hairline, avoiding neck scarring. In addition, in addition to primary site resection and neck clearance, robotic-assisted surgery has also been applied by foreign plastic surgery alone to repair and reconstruct head and neck tumors after resection, from the early use of flaps to cover and suture surgical defect wounds to avoid facial incisions and mandibular fissures [9] to the current application of excision and preparation of tipped or free flaps. Robot-assisted flap preparation makes the repair and reconstruction techniques more minimally invasive and refined, and more in line with the requirements of plastic surgery techniques [16]. IV. Outlook Minimally invasive surgery with its advantages of beauty minimally invasive and aesthetic is penetrating the related medical diagnosis and treatment fields, among which robot-assisted surgery has been very representative of the progress of minimally invasive surgical techniques in the past 10 years or so. In addition to the general characteristics of minimally invasive surgery, it also has the characteristics of good operability and visibility, and can be operated remotely. With the Internet and satellite technology makes it possible to share telesurgical techniques in real time across regions [17]. However, the clinical practice of robotic surgical systems in head and neck surgery is still very limited and their disadvantages should be fully recognized. Firstly, robotic-assisted systems are expensive to acquire and regularly maintain, and domestic medical institutions should not blindly follow the need to fully consider the cost-benefit issue [3]. Second, because of the relatively short clinical application of this technology at present, it is mostly a single-center treatment experience, and the efficacy lacks confirmation in multicenter and large-scale clinical studies. Thirdly, compared to conventional lumpectomy, robotic surgery still requires continued development of supporting instruments and training, as well as standardization of technical procedures and addressing the lack of tactile feedback for surgical operations [18]. Despite the significant improvement in visual performance compared with conventional lumpectomy, the overall operating field is still less comprehensive than that of open surgery, and the surgeon’s handling is poorer due to the lack of tactile feedback, and the impact of active bleeding on the entire operation and the process of hemostasis is more difficult than that of conventional open surgery. Since it has been put into clinical application for a relatively short period of time, its long-term efficacy and cost-effectiveness need further research to be confirmed. In conclusion, with the continuous development of supporting instruments and the solution of haptic feedback, robot-assisted surgery will open up a new treatment technology in the field of head and neck tumor treatment, especially the use of its remote control and minimally invasive advantages will greatly enhance the quality of minimally invasive surgical procedures such as thyroid and early head and neck tumors.