Transoral robotic surgery for parapharyngeal lesions: a case series of four benign tumours

The parapharyngeal space (PPS) is an anatomically complex space in the vicinity of vital structures. With the introduction of the daVinci robot in head and neck surgery, the surgical robotic system is now being used to gain direct access to the parapharyngeal space and to excise the tumors endoscopically. This study evaluates the outcomes of four patients with benign PPS tumors treated with a transoral robotic surgery approach in a single centre.

All patients with benign tumors of the PPS who underwent transoral resection (between January 2012 and June 2014) using the robot were included in this retrospective study.

The study population comprised of two males and two females with a mean age of 52 (range 34-66 years). The parapharyngeal mass was successfully transorally removed in all cases. Overall, mean length of stay was 3.25 days with mean time to oral diet of one day. No intraoperative, perioperative or postoperative complications were encountered. The histological diagnosis was pleomorphic adenoma in two cases (50%). The other two cases were: schwannoma and angioma. There were no recurrences on radiological investigations during a mean follow-up of 14.5 months. MRI scan showed a stable residual fibrotic lesion in case of the angioma. The preoperative complaints of mucus in the throat, painless swelling of the soft palate or throat burden of all patients resolved after surgery.

With the assistance of the surgical robotic system, benign tumors within the PPS can be excised safely without neck incisions. Further long-term evaluation is needed to define patient selection and the role of TORS for PPS neoplasms.