Surgical robots such as the da Vinci surgical system allow for a clear surgical view with three-dimensional high-definition endoscopy and use of miniaturized tools, which can be employed like standard surgical instruments and enable arm movements with tremor filtration. Surgical robots have already been used in several departments. In cases of esophageal cancer, mediastinal tumor, and laryngo-pharyngeal cancer, the da Vinci surgical system has been introduced and robot surgery is increasing. Transoral robotic surgery (TORS) has been used in removing pharyngeal and laryngeal cancers to improve functional and aesthetic outcomes without worsening survival rates. TORS for pharyngeal and laryngeal cancers is now covered by health insurance in Japan, and use of TORS has increased as a result. Overseas, robotic surgery has already been performed for other diseases. In Japan, further expansion of indications of robotic surgery is expected in the future.

In Japan, transoral robotic surgery (TORS) was approved for pharmaceutical and medical usage in 2018 and has been covered by insurance since 2022. To date, the total number of cases of TORS has exceeded 700, making it an increasingly important treatment option. As of April 30, 2024, there are 26 qualified TORS proctors, 98 console operators, 66 assistant operators, and 54 certified facilities. Good candidates for TORS are cases that meet the criteria of being oropharyngeal cancer, scoring T2 or lower, and having no lymph node metastasis with extranodal invasion. Currently, da Vinci Xi, the most widely distributed drug, has limited applications for hypopharyngeal and laryngeal lesions, and it is hoped that availability of da Vinci Sp will become more widespread. In Japan, however, with oropharyngeal cancer the TORS group has demonstrated a significantly lower positive margin rate than the arthroscopic transoral resection group. TORS is a minimally invasive treatment that can be performed on elderly patients, but because it is a raw surface treatment, there is a risk of postoperative bleeding. Because such bleeding can be a fatal complication, in preparation a sufficient backup system is necessary. In order to further develop robotic surgery for the laryngopharynx region, a multifaceted approach is required, including the development of instruments and human resource development.

The standard treatment for thyroid tumors is surgical resection, usually through a 5 to 10 cm collared incision in the anterior neck skin. Thyroid tumors are more common in women and also occur in younger patients, and video assisted neck surgery (VANS) is performed in consideration of cosmetic aspects. However, with VANS it is difficult to grasp the surgical field anatomically because the field of view is different from that of an external incision, and the operation space is narrow and restricted, making it a surgery that requires skill. Robot-assisted thyroid surgery using the da Vinci Surgical System with various approaches has been reported, mainly in Korea. At our institution, we started trans-axillary robot-assisted thyroid surgery (TART) using da Vinci Xi in March 2022 after verification through cadaver training, and also introduced a new model, the da Vinci Sp. To date, 8 cases of TART have been performed at the patient's own expense. Compared to VANS, TART has no difference in operative time, blood loss, postoperative complications, or hospital stay, and is highly pleasing cosmetically, resulting in high patient satisfaction. This paper describes our introduction and initial experience with TART and outlines its current status and future prospects.

Background: Robotic-assisted thoracoscopic surgery (RATS) in the field of respiratory surgery in Japan was approved by the Pharmaceutical Affairs Committee in 2009, and lung lobectomy and surgery for mediastinal tumors were covered by insurance starting in April 2018. In April 2020, segmental lung resection was added to the surgical procedure, and the number of cases increased further, as the usefulness of segmental resection for small lung cancer was demonstrated. From 2024, benign lung tumors are to be covered by insurance for this procedure, and further development of RATS is expected. Based on our own experience, we examined the current status of and issues surrounding RATS, and considered this surgery's future prospects. Subjects and Methods: We evaluated 464 cases of RATS (360 cases of lung tumors, 104 cases of mediastinal tumors) performed from 2013 through April 2024, mainly perioperative data. Results: Perioperative data such as operative time (console time) were within an acceptable range for each surgical method, and laboratory data such as inflammatory response were better with RATS than with VATS. Discussion: RATS is well tolerated in routine procedures, and because of its good field of view and ease of use, it may be suitable for advanced procedures. It is expected that the number of surgical applications and procedures will expand in the future.

In recent years, robotic surgery has become increasingly popular as a surgical treatment for esophageal cancer, and reports on its outcomes are increasing. In particular, compared to endoscopic surgery, robotic surgery is associated with a lower incidence of postoperative complications and a reduction in surgical stress. Ongoing randomized controlled trials have focused on comparing the quality of lymph node dissection between robotic and thoracoscopic surgery, with some trials showing the superiority of robotic surgery. However, definitive conclusions regarding long-term outcomes or treatment efficacy comparisons remain elusive. Additionally, the adoption of robotic surgery presents challenges in terms of cost and technical requirements. Nevertheless, advancements in teleoperation and educational systems hold promise for enhancing the quality and accessibility of medical care. As robotic surgery assumes a pivotal role in the treatment of esophageal cancer, further advancements are anticipated.