Flexible robotic surgery for head and neck cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on May 19, 2022.

The Flex® Robotic System is a surgical system with a flexible robotic endoscope. The minimally invasive technology allows surgeons to access hard-to-reach areas of the mouth and throat. Its flexible scope is designed to allow surgeons to view and reach areas of the oropharynx (the part of the throat directly behind the mouth), the hypopharynx (the part of the throat that serves as the entrance to the esophagus) and the larynx (the voice box) that aren’t typically or easily accessible with standard instruments. A traditional endoscope moves in straight lines and is limited to lines of sight.

The Flex Robotic System operates through natural openings and is designed to reach areas of the throat that may have previously required large incisions in the neck. Benefits may include:

  • Shorter hospital stays
  • Reduced post-surgical pain
  • Quicker recovery
  • Less damage to tissues and muscles critical to eating and other daily activities
  • Lower risk of infection and complications
  • Less blood loss (and fewer transfusions)
  • Less scarring
  • Faster return to normal activities

City of Hope otolaryngology surgeons who perform surgeries using the Flex Robotic System are highly trained to use the technology to treat patients with head and neck cancer.

How it works

In traditional minimally invasive surgery, the surgeon operates while standing, using hand-held instruments that cannot bend or rotate. The surgeon looks up and away from the operating table to view images on a standard 2-D video monitor.

The robotic da Vinci® Surgical System helped advance minimally invasive surgery by allowing the surgeon to operate from a comfortable, seated position at a console, with eyes and hands in line with the instruments, and a magnified, high-definition 3-D view of the target anatomy surgical site.

The Flex Robotic System, the most recent innovation to minimally invasive surgery, is designed to overcome previous line-of-sight limitations by allowing the surgeon more flexibility in movements. The surgeon can move the flexible robotic endoscope and navigate a nearly 180-degree path to reach challenging areas. The flexibility is designed to offer:

  • Greater surgical precision
  • A clear view of the navigation path and surgical site
  • Improved angle of approach
  • Increased exposure to the surgical site
  • Increased range of motion
  • Improved dexterity
  • Enhanced visualization, including areas that may not be seen by the naked eye
  • Improved access to hard-to-reach areas
  • Improved ability to spare healthy tissue not impacted by cancer

In using the Flex Robotic System in a surgical procedure, the surgeon inserts the camera and instruments through the mouth. The camera allows the surgeon to view a highly magnified, high-resolution image of the surgical site.The surgeon then uses joystick-like controls to direct the scope to the surgical site. Once in place, the scope serves as a stable surgical platform. The system translates the surgeon’s hand, wrist and finger movements into precise movements of the instruments in real time.

The system is designed so that it cannot be programmed or perform without the surgeon’s direction, allowing the surgeon to control the entire procedure.

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