Robotic-assisted parotidectomy as a remote-access alternative to conventional open surgery: a single-center comparative experience

PURPOSE: Robot-assisted parotidectomy is a remote-access alternative to conventional open parotidectomy, but comparative data remain limited. This study evaluated perioperative safety, facial nerve preservation, complications, and pathological outcomes of da Vinci robot-assisted versus conventional open parotidectomy. METHODS: Patients who underwent parotidectomy by a single experienced head and neck surgeon at a regional teaching hospital between January 2020 and January 2026 were retrospectively reviewed. Baseline characteristics, operative details, facial nerve outcomes, complications, pathological findings, and recurrence were compared between da Vinci robot-assisted and conventional open approaches. RESULTS: Seventy-four patients were included: 23 underwent robotic parotidectomy, including 17 da Vinci Xi and 6 da Vinci SP cases, and 51 underwent conventional open parotidectomy. The robotic group was younger, 44.52 ± 13.89 versus 51.78 ± 17.27 years, p = 0.015, and had more female patients, 60.9% versus 27.5%, p = 0.006. All robotic cases were completed without conversion. Operative time was longer in the robotic group, 183.6 ± 56.2 versus 141.7 ± 84.6 min, p = 0.034, whereas blood loss, drainage outcomes, and hospital stay were comparable. No immediate or transient facial palsy occurred in the robotic group, and no permanent facial paralysis occurred in either group. Negative margins were achieved in all robotic cases. Hypertrophic scar or keloid occurred in 2 robotic patients, 8.7%, and no open patients. CONCLUSION: da Vinci robot-assisted parotidectomy was feasible and safe in selected patients with benign or non-neoplastic lesions. Its concealed-incision benefit should be balanced against longer operative time, scar-related trade-offs, and the need for larger platform-specific studies.