Transoral Robotic Surgery for Laryngeal Cleft Types I to III: A Systematic Review and Narrative Synthesis of Techniques, Outcomes, and Safety

Background: Laryngeal clefts are rare congenital aerodigestive tract anomalies that cause chronic aspiration, feeding difficulties, and recurrent respiratory infections in children. Types I to III clefts remain challenging because of limited exposure and technical constraints. Transoral robotic surgery (TORS) has emerged as a potential minimally invasive alternative, offering enhanced visualization and instrument articulation. However, evidence regarding its feasibility, safety, and clinical effectiveness in pediatric laryngeal cleft repair remains limited and fragmented. This systematic review synthesizes available evidence on robotic repair of Types I to III laryngeal clefts. Materials: A systematic search of PubMed, Scopus, Embase, ScienceDirect, the Cochrane Library, CINAHL, and Google Scholar was conducted in accordance with PRISMA 2020 guidelines. We performed study selection, data extraction, and quality appraisal using the Joanna Briggs Institute tools. Due to heterogeneity and the absence of comparator groups, a narrative synthesis was undertaken. Results: Four studies comprising 29 attempted robotic repairs were included, of which 26 procedures were successfully completed robotically. Robotic repair was applied to Type I (n = 19), Type II (n = 7), and Type III (n = 3) clefts using transoral robotic platforms, predominantly the da Vinci system. Early feasibility studies reported conversion due to exposure limitations, whereas later studies demonstrated 0% conversion rates. Postoperative improvement in swallowing or aspiration was reported in ~70% to 82% of Type I, 75% of Type II, and 67% of Type III clefts. Complications were infrequent, mild, and transient, with no procedure-related mortality or need for tracheostomy. Conclusion: Current evidence suggests that TORS is a feasible and safe adjunct for selected pediatric patients with Types I to III laryngeal clefts, particularly Type II and carefully selected Type III lesions. While routine use in uncomplicated Type I clefts offers limited advantage over standard endoscopic repair, robotic assistance may provide meaningful benefits in anatomically complex cases.