Single incision-plus approach for gasless endoscopic parotidectomy: a seven-step procedure

Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.