Transoral Robotic Cleft Palate Surgery: Communication-Related Outcomes and Feasibility

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Abstract
Treatment of cleft lip alveolus and/or palate includes surgical repair to treat communication-related outcomes such as velopharyngeal insufficiency and otological dysfunction. Robot-assisted surgery has recently evolved into a promising adjunct to conventional surgery, particularly for complex procedures such as transoral (reconstructive) surgery. This structured literature review aims to investigate whether robot-assisted transoral cleft palate repair enhances communication (i.e., speech and otological) outcomes compared to conventional manual cleft palate surgery. A literature search was performed using PubMed, Embase, the Cochrane Library and Google Scholar. Primary outcomes were the change in cleft speech characteristics and otological disease after robot-assisted cleft palate surgery versus manual cleft palate surgery. The available evidence on communication-related outcomes remains sparse. Six relevant articles were included. In only one study, transoral robotic cleft surgery (TORCS) significantly reduced otitis media with effusion (OME), need for ventilation tubes and hearing threshold within 2 years post-surgery. No postoperative speech or velopharyngeal outcomes were reported. In conclusion, transoral robotic cleft surgery (TORCS) appears safe and feasible for repair of a cleft palate. It provides superior intraoral view and improved surgeon ergonomics. Current drawbacks are the costs and the available tools, the extended surgical duration and the lack of haptic feedback, which limit the current clinical applicability of TORCS. Based on limited clinical evidence, TORCS may support faster recovery of Eustachian tube function and hearing, but no conclusions on speech outcomes can yet be drawn.

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