Systematic review of laryngocele and pyolaryngocele management in the age of robotic surgery

Abstract

Objective A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We conducted a systematic review of the literature regarding the surgical management of laryngoceles and pyolaryngoceles, to understand the evolving nature of treatment for this rare condition. Methods We searched for publications in the PubMed, Cochrane Library, JBI Library of Systematic Reviews, and Ovid databases using the terms “laryngocele”, “pyolaryngocele”, and “laryngopyocele”, and reviewed the identified articles. Results After removal of repeated studies and filtering for relevance and studies written in English, a total of 227 studies were included in this review. No meta-analyses or randomized controlled trials have been published. The identified studies have been summarized in 14 reviews conducted since 1946. The meta-analysis determined that endoscopy was the preferred approach for internal laryngoceles, while combined laryngoceles benefited from both internal and external surgical approaches. Conclusions Laryngocele management has progressed since its initial description, from open surgery to an endoscopic approach, and more recently to a robotic-assisted surgical approach. The uptake of robotic surgery as a possible treatment modality over the last decade shows much promise for the treatment of these conditions.

Endoscopic CO2 Laser Resection Using the Inversion Technique in 22 Combined Laryngoceles

“…Recent developments enable the use of transoral robotic surgery (TORS) to remove (combined) laryngoceles. TORS may offer better exposure and more angled and wider visualisation 9–12 . However, TORS is expensive and not widely available (yet) and it is furthermore associated with a longer hospital stay and more often seems to require a postoperative nasogastric feeding tube 2 …”

“…TORS may offer better exposure and more angled and wider visualisation. [9][10][11][12] However, TORS is expensive and not widely available (yet) and it is furthermore associated with a longer hospital stay and more often seems to require a postoperative nasogastric feeding tube. 2 In conclusion, to our knowledge, our study describes the largest series of patients with a combined laryngocele treated by endoscopic CO 2 laser resection.…”

Pyolaryngocele: Case report

“…Several aggravating factors are also identified, particularly repeated hyper-pressure at the glotto-sus glottic level, as can be observed in chronic coughs, glass-blowers, singers, and wind instrument players [ 1 , 7 ]. Cases of pyolaryngocele associated with laryngeal tumors and intravenous neck injection due to drug abuse have been reported in the published studies [ 7 , 13 ]. Common pathogens include Staphylococcus aureus , hemolytic Streptococcus B, Escherichia coli , and Pseudomonas aeruginosa [ 4 ].…”

CO2 Laser Marsupialization for Internal and Combined Laryngocele

“…6 Moreover, in case of infection of this dilatated saccule, it becomes a laryngopyocele that could cause acute respiratory obstruction. 7 This clinical entity is a rare disease, 6 usually combined and unilateral, 8 that occurs five times more frequently in males between the 5 th and the 6 th decades of life. 9,10 Currently, treatment of laryngocele includes several surgical therapeutic strategies: endoscopic approach (CO2 laser, microdebrider, cold instrumentation), open surgery (thyrotomy, transthyrohyoid membrane approach), and transoral robotic surgery (TORS).…”

“…9,10 Currently, treatment of laryngocele includes several surgical therapeutic strategies: endoscopic approach (CO2 laser, microdebrider, cold instrumentation), open surgery (thyrotomy, transthyrohyoid membrane approach), and transoral robotic surgery (TORS). 7,[11][12][13][14][15] However, there is no consensus on the best treatment for laryngocele. To date, the endolaryngeal approach is performed for most internal laryngoceles.…”