Transoral Robotic Resection of Parapharyngeal Space Tumors

Parapharyngeal space tumors are routinely resected by transcervical or transmandibular approaches. However, recent developments in techniques of transoral robotic surgery (TORS) now enable using the da Vinci robotic system for removal of parapharyngeal space tumors with minimal morbidity. In this chapter, we describe in detail the setup and surgical technique of TORS for removal of large parapharyngeal tumors. TORS provides high magnification and three-dimensional visual access to lateral-based structures and enables angled visualization and instrumentation superior and medial to the tumor. The 5 mm robotic-guided arms enable an assistant to introduce additional instruments into the operating field to aid retraction, suction, and cauterization. We also describe an extension of this technique, combining an endoscopic transcervical approach to enhance safe inferolateral release of parapharyngeal tumors under direct visualization of vital neurovascular structures. Robotic surgery is rapidly becoming integrated into head and neck surgery. The utility of TORS improves the surgical removal of selected tumors in the parapharyngeal space, with minimal morbidity and excellent functional and cosmetic outcomes.