Modular approach to the parapharyngeal space based on transoral robotic surgery

Objective: Lesions of the parapharyngeal space can be resected through a variety of approaches, depending on their location and biology, as well as on the surgeon's experience. Historically, the transcervical approach has been the most employed, while the transoral has been neglected because of its intrinsic limitations. The advent of robotic surgery has expanded the indications of transoral resection thanks to its reduced morbidity and the possibility of combination with other accesses. Methods: We conducted a retrospective analysis of patients submitted to transoral robotic surgery (TORS) for parapharyngeal lesions at the European Institute of Oncology. We further focused on patients treated with a combined transoral-transcervical approach. Results: Between 2013 and 2024, 43 patients underwent TORS for a parapharyngeal lesion, with curative intent in the majority of cases (93%). In 9 cases (19%), a transcervical/trans-parotid approach was combined with TORS. A transmandibular approach was never necessary. The postoperative course was uneventful for all patients. The majority of lesions were benign (79%). Conclusions: TORS has proven to be a viable option for lesions of the parapharyngeal space. A combined modular approach is feasible to lessen surgical morbidity.