Transoral robotic resection of parapharyngeal space tumors

Parapharyngeal space (PPS) tumors are routinely resected by a transcervical or transmandibular approaches. However, recent developments in techniques of transoral robotic surgery (TORS) now allow the utility of the da Vinci robotic system for removal of PPS tumors with minimal morbidity. In this paper, we describe in detail the setup and surgical technique of TORS for removal of large parapharyngeal tumors. TORS provides high-magnification, 3-dimensional visual access to lateral-based structures and enables direct visualization at and around 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. Robotic surgery is rapidly becoming integrated into transoral head and neck surgery. The utility of TORS improves the surgical removal of selected tumors in the PPS with minimal morbidity and excellent functional and cosmetic outcomes.