Various incisions are used in parotid surgery, yet they often result in visible scarring on the neck and potential deformities. The periauricular approach is feasible for parotid tumors across all levels of the parotid gland. Its cosmetic advantage lies in the smaller scar size that does not extend into the neck.

Eighty-five percent of nasopharyngeal carcinoma (NPC) cases present with lymphadenopathy, most commonly involving level II cervical lymph nodes and the retropharyngeal space. The surgical management of recurrent lymph node (LN) metastases in the retropharyngeal space is particularly challenging due to the complexity of the anatomy and the destructive nature of traditional open surgical approaches, such as maxillary or mandibular swing techniques. With the advent of the da Vinci surgical robot, transoral robotic surgery (TORS) has been adopted as a minimally invasive approach to remove retropharyngeal LN metastases. In this program, we will demonstrate the use of the da Vinci Xi system to excise retropharyngeal lymph nodes using three instruments: Maryland Bipolar Forceps, Monopolar Curved Scissors, and ProGrasp Forceps. Enhanced traction and countertraction provided by the ProGrasp Forceps, combined with the assistance of a bedside surgeon, enable safe and precise dissection of the retropharyngeal LN. The procedure ensures effective hemostasis and benefits from high-magnification, interchangeable 30-degree upward or downward 3D endoscopy. Additionally, the tremor reduction and motion filtration features of the da Vinci Xi system allow a robotic surgeon with 15 years of experience to perform complex two-surgeon, four-handed procedures in a confined space with greater dexterity and precision. (Video link https://zenodo.org/records/15537792 )