Endoscopic parotidectomy reduces blood loss and drain output but clinical impact is limitedEndoscopic surgery shows lower blood loss for parotid gland tumors

Endoscopically-assisted parotid gland surgery has been increasingly adopted as a minimally invasive alternative to conventional open parotidectomy, aiming to improve perioperative outcomes and cosmetic results while maintaining surgical safety. This systematic review and meta-analysis synthesized contemporary comparative evidence on endoscopic versus conventional parotid gland surgery. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, CENTRAL, and Google Scholar was conducted from inception to December 14, 2025. Observational and interventional studies comparing endoscopically-assisted or fully endoscopic parotidectomy with conventional open surgery in adult patients were included. Study quality was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist, and certainty of evidence was evaluated using the GRADE framework. Random-effects meta-analyses were performed to calculate pooled mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes, with heterogeneity quantified using the I statistic. Eleven studies involving 1188 patients were included. Tumor diameter and operative time did not differ significantly between the endoscopic and conventional groups. Endoscopic parotidectomy was associated with significantly reduced intraoperative blood loss (MD -42.28 mL, 95% CI -61.56 to -23.01) and lower postoperative drain output (MD -40.73 mL, 95% CI -68.60 to -12.86). No statistically significant differences were observed for drain duration, salivary fistula formation, auricular skin numbness, or Frey syndrome. A lower OR of temporary facial nerve dysfunction was observed in the endoscopic group, while permanent facial nerve paralysis and surgical site infection rates were low and comparable between approaches. All included studies were of moderate methodological quality, and the overall certainty of evidence was low. Endoscopic parotid gland surgery appears to be a feasible alternative to conventional parotid gland surgery in selected patients, providing modest perioperative advantages without compromising postoperative outcomes. However, the small absolute magnitude of these differences suggests limited clinical impact, indicating that this approach represents a cosmetically favorable and safe option rather than a clearly superior technique. Given the limited number of studies, regional concentration of the available evidence, and substantial heterogeneity across several outcomes, further high-quality, multicenter prospective studies are needed to better define its clinical significance and generalizability.