Background: Endoscopy during middle ear surgery is advantageous for a better exploration of the middle However, using an endoscope shows some weakness as a surgical gesture is performed by one hand. This may disturb surgeons accustomed to two-handed surgery which affects accuracy and guidance. A robot-based holder may combine the benefits of endoscopic exposure and a twohanded technique. The purpose of this study was to assess the safety and value of an endoscope held by a teleoperated system such as the RobOtol® (Collin Medical, Bagneux, France). Methods: A case series of 32 consecutive patients operated with an endoscopic exposure with robot-based assistance were analyzed retrospectively. The RobOtol® system was teleoperated as an endoscope holder alone or in combination with the microscope. Available endoscopes were 0° or 30° and 3.3 mm diameter (Karl Storz, Tuttlingen, Germany). Patient demographics, indications for surgery, procedure type, complications, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air and bone conduction threshold, air-bone gap, air-bone gap gain, word recognition score, at 3 months-postoperative mean operation duration were collected. Patient had a type I (myringoplasty), II (partial ossiculoplasty), or III (total ossiculoplasty) in 14, 13, and 3 cases, respectively. In 2 cases, patients had a partial petrosectomy for extended cholesteatoma to the petrous apex with posterior labyrinth drilling. Ambulatory procedure was carried out in 22 out of 32 patients (69%). Results: Mean postoperative surgical duration was 157±9.8 min [53-313 min]. Complete healing with no perforation of tympanic membrane was noted in postoperative in all patients. No complications related to the robot manipulation occurred during surgery nor in postoperative. Mean bone conduction variation was 1±3.5 dB (mean± SEM). Mean air conduction gain was 11±4.5 dB for type I (n = 14), 11±4.8 dB for type II (n = 13), or 35±29 dB for type III (n = 3) tympanoplasty, respectively. Postoperative air-bone conduction gap was 12±4 (n = 14) dB for type I, 19±4.3 dB for type II, or 14±7.9 dB for type III tympanoplasty. Conclusion: This study shows that robot-assisted endoscopy is a safe and trustworthy tool for several categories of middle ear procedures. It combines the benefits from endoscopic exposure and a two-handed technique in the surgery of the middle ear. It can be used as a standalone tool for pathology limited to the middle cleft or in combination with the microscope in an extended lesion to the mastoid or petrous apex.