Parapharyngeal space surgery via a transoral approach using a robotic surgical system: transoral robotic surgery.

OBJECTIVE: In transoral robotic surgery (TORS), if an endoscopic arm equipped with two integrated cameras is placed close to a lesion, a three-dimensionally magnified view of the operative field can be obtained. More important is that the operation can be performed precisely and bimanually using two instrument arms that can move freely within a limited working space. We performed TORS to treat several diseases that occur in the parapharyngeal space (PPS) and subsequently analyzed the treatment outcomes to confirm the validity of this procedure.

PATIENTS AND METHODS: Between February 2009 and February 2012, 11 patients who required surgical treatment for the removal of a parapharyngeal lesion were enrolled in this prospective study. Nine patients received TORS for parapharyngeal tumor resection, and 2 patients with stylohyoid syndrome underwent TORS for resection of an elongated styloid process. The average age of the patients included in this study was 42 years. Five patients were male, and 6 patients were female.

RESULTS: TORS was successfully performed in all 11 patients. The average robotic system docking and operation times were 9.9 minutes (range, 5-24 minutes) and 54.2 minutes (range, 26-150 minutes), respectively. Patients were able to swallow normally the day after the operation. The average blood loss during the robotic operation was minimal (11.8 mL). The average hospital stay was 2.6 days. There were no significant complications in the perioperative or postoperative period. All patients were extremely satisfied with their cosmetic outcomes.

CONCLUSIONS: PPS surgery via a transoral approach using a robotic surgical system is technically feasible and secures a better cosmetic outcome than the transcervical, transparotid, or transmandibular approach. This new surgical method is safe and effective for benign diseases of the PPS.