Reconfiguring robotic surgery in head and neck practice: transition from multi-port to single-port with early clinical outcomes

Background: The integration of the da Vinci single-port (SP) platform into head and neck practice represents a major transition from conventional multi-port robotic systems, yet real-world data on early institutional adoption remain limited. This study evaluated the clinical integration of the SP platform during an early implementation period, with particular focus on case accrual, diversification of surgical access routes, surgeon-specific adoption patterns, and temporal evolution of case selection. Methods: This retrospective observational study included consecutive robotic head and neck procedures performed with the da Vinci SP system at a single institution during a 9-month transition period prior to the installation of a second SP system. Clinical, operative, and perioperative variables were extracted from an amended institutional dataset and operative records. Cases were analyzed overall, compared between the 2 primary surgeons, and chronologically stratified into Early and Later phases. Results: A total of 64 cases were performed, including 34 malignant (53.1%) and 30 benign (46.9%) lesions. Case accrual increased steadily throughout the study period. Transoral surgery was the most common access route (42/64, 65.6%), followed by transoral plus transcervical (12/64, 18.8%), transcervical alone (5/64, 7.8%), and retroauricular access (5/64, 7.8%). Surgeon 1 performed 51 cases and treated an older population with significantly higher rates of tobacco, alcohol, and betel quid exposure, more malignant disease, and broader anatomic distribution. Surgeon 2 performed 13 cases, all through a transoral approach, predominantly for benign lesions. A chronological comparison between the Early and Later phases showed stable surgeon distribution, pathology patterns, and approach patterns, but oral cavity cases and reconstructive procedures became more prominent in the Later phase. Cumulative accrual curves for benign and malignant disease progressed in parallel, suggesting that SP adoption expanded across both oncologic and benign indications rather than being confined to a single clinical niche. Conclusion: Early institutional integration of the da Vinci SP platform was associated with steady case accrual, expansion of operative access pathways, and broad adoption across malignant and benign head and neck indications. These findings provide real-world evidence that transition from multi-port to single-port robotic surgery can be achieved successfully within a high-volume head and neck program.