Transaxillary Totally Endoscopic Robot-Assisted Ansa Cervicalis to Recurrent Laryngeal Nerve Reinnervation for Repair of Unilateral Vocal Fold Paralysis

Abstract

Pediatric unilateral vocal-fold paralysis represents a source of significant morbidity, for which treatment options are quite limited. Conventional management strategies suitable for adults are not appropriate for the developing larynx. In this study, we report the first experience with minimally invasive laryngeal reinnervation. While open techniques for pediatric recurrent laryngeal nerve reinnervation have been performed, these require large, visible incisions, which limit the appeal of this technique. The transaxillary endoscopic approach to the neck significantly reduces pain and recovery time from cervical surgery. In this study, we report the feasibility of transaxillary totally endoscopic robot-assisted laryngeal reinnervation for unilateral vocal-fold paralysis. Operative time was less than 3 hours, and patients were discharged the day of surgery. No postoperative narcotics were required. Initial results are favorable.

Medialization versus reinnervation for unilateral vocal fold paralysis: A multicenter randomized clinical trial

“…We speculate that younger patients have greater neuroregenerative potential than older patients, and thus achieved a better reinnervation result; and that they may also have a greater ability to adapt their phonatory motor patterns to the changes produced by UVFP and subsequent reinnervation. Smith et al21 reported excellent results with ansa‐RLN reinnervation in a group of 12‐ to 21‐year‐olds; the procedure has even been performed with a transaxillary, robotic‐assisted approach in children 22. The ML procedure does not require nerve healing and might be expected to give similar results in all age groups, as found in this study.…”

Systematic review of laryngeal reinnervation techniques

“…), reinnervation of posterior cricoarytenoid for bilateral vocal fold paralysis, being review articles, and/or lack of a description of clinical management. After a review of the remaining 20 articles, 10 additional reports were excluded because of duplicate patients, 22–28 a lack of preoperative values, 29 exclusive focus on two children, 15 and focus on a novel approach used on only two patients 30 . From the 284 references of the 10 remaining articles, 31–40 an additional four publications 13,41–43 were identified and included after a manual crosscheck of the bibliography.…”

“…After a review of the remaining 20 articles, 10 additional reports were excluded because of duplicate patients, [22][23][24][25][26][27][28] a lack of preoperative values, 29 exclusive focus on two children, 15 and focus on a novel approach used on only two patients. 30 From the 284 references of the 10 remaining articles, [31][32][33][34][35][36][37][38][39][40] an additional four publications 13,[41][42][43] were identified and included after a manual crosscheck of the bibliography. Unpublished reports were not considered (Fig 1).…”

A Novel Endoscopic Arytenoid Medialization for Unilateral Vocal Fold Paralysis

“…Laryngeal reinnervation procedure might be the ideal solution for vocal fold medialization via rehabilitation of the tone of the adductor muscles without any foreign body implantation. This surgical method still has not achieved general acceptance, although younger patients with higher neuroregenerative potential could benefit from this approach 40–45 …”