Abstract
Abstract
Introduction:
We present a unique surgical treatment for an isolated papillary thyroid carcinoma recurrence in the parapharyngeal space. This 48-year-old male, with a history of multiple procedures for metastatic papillary carcinoma, developed a new, superiorly located, left parapharyngeal space recurrence discovered on MRI obtained for cancer surveillance.
Materials and Methods:
The DaVinci Robotic System is used to excise the parapharyngeal metastatic node through a transoral approach. Given the superior, medial location in the parapharyngeal space, a transcervical approach would require mandibulotomy and dissection along the internal carotid to the skull base, with risk to multiple neurovascular structures. Although we have successfully employed this approach in other similar cases, it was anticipated that scarring from this patient's previous operations would add significant challenge and risk. When compared with a traditional transoral approach, the use of the DaVinci Robotic System offers some critical advantages. The magnified three-dimensional view and angled scopes on the robot prevent the line-of-sight limitations of a simple transoral approach. In addition, two robotic arms and the two hands of the bedside assistant allow for increased dexterity in a very limited space.
Results:
The parapharyngeal node is excised en bloc without complication through a transoral approach using the DaVinci Robotic System. The typical indications for transoral robotic surgery are discussed, including accepted applications in head and neck oncology. The setup and patient preparation are discussed and demonstrated. Technical details of the procedure are highlighted as they are revealed in the video. The patient's postoperative course is discussed, as well as the advantages of this approach in our patient.
Conclusion:
A transoral approach can be considered for isolated recurrences in the parapharyngeal space and may offer advantages over traditional approaches.
No competing financial interests exist.
Runtime of video: 8 mins 13 secs
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