Robot-assisted Parotidectomy: Improved Clinical and Patient-Reported Outcomes.

Abstract

To compare perioperative outcomes, postoperative safety, and patient-reported outcomes among conventional, endoscopic, and robot-assisted parotidectomy for primary benign parotid tumors. Retrospective comparative study. Tertiary academic institution. A total of 212 adults undergoing parotidectomy were enrolled from January 2022 to June 2025. All operations were performed by a single medical team; robot-assisted and endoscopic procedures were performed by a single surgeon to reduce learning-curve variation. Outcomes included perioperative metrics, short- and long-term complications, local recurrence, scar visual analog scale, and Parotidectomy Outcome Inventory-8 scores. Inverse probability of treatment weighting was used to reduce confounding; effect estimates are reported as weighted mean differences and odds ratios with 95% confidence intervals. Among 212 patients (78 conventional, 106 endoscopic, 28 robot-assisted), statistical analyses showed that despite longer operative times (vs endoscopic: +41.63 minutes; vs conventional: +56.04 minutes), robot-assisted parotidectomy resulted in lower blood loss (vs endoscopic: -14.03 mL; vs conventional: -10.30 mL). Compared to endoscopic surgery, it exhibited a lower risk of long-term complications, including facial nerve palsy (-78% in odds). Compared to conventional surgery, both minimally invasive approaches achieved shorter incisions (robot-assisted: -4.41 cm; endoscopic: -4.71 cm) and improved patient-reported outcomes, while robot-assisted surgery additionally reduced the risk of short-term complications. No increased perioperative or postoperative risk was observed. Robot-assisted parotidectomy was associated with improved clinical and patient-reported outcomes without evidence of increased risk. Its clinical value warrants further validation in prospective multicenter cohorts.