Transoral Robotic Surgery Total Laryngectomy

Abstract

Objective: The aim of our study is to demonstrate our technique for performing transoral robotic surgical total laryngectomy (TORS-TL) with the use of the da Vinci robotic system. Materials and Methods: We provide a comprehensive description of the TORS-TL operative techniques. Two fresh-frozen human cadavers were selected after ethics approval to describe the appropriate step-by-step surgical resection. We adopted a 5-step procedure that was later applied to 2 of our patients. The first patient presented initially with a squamous cell carcinoma (SCC) in the laryngeal glottis area. A lack of clinical response to initial treatment by chemoradiotherapy led to the decision of performing salvage TL surgery. The second patient had a previous history of head and neck SCC (HNSCC); he had no recurrence of his primary tumor but suffered significantly from postoperative breathing and swallowing difficulties due to severe laryngeal incompetence. Results: TORS-TL was successfully performed in all cases. The operative time for the cadavers was approximately 65 and 55 min, respectively. It was significantly longer for the patients, 210 and 235 min, respectively, despite the fact that exactly the same steps were followed throughout all procedures. There were no intra- or postoperative complications or surgical morbidity related to the use of the da Vinci system. Conclusion: TORS-SL for SCC was performed in a safe, reliable, and smooth manner and was shown to be successful in treating our patients. We thus believe that our step-by-step surgical technique for TORS-SL is efficient and reproducible.

Hybrid procedure for total laryngectomy with a flexible robot‐assisted surgical system

“…The surgical technique of TORS‐TL was previously published, and the following surgical steps were adapted from existing descriptions . A horizontal skin incision is performed in the midline between the laryngeal cartilage and the jugulum, and pre‐laryngeal strands of the strap muscles are positioned laterally to give way to the trachea.…”

“…The anterior tunnel is further advanced and completed in a caudal direction with the needle knife along the cartilaginous body of the larynx (Figure b and c). For this surgical step, the cricoid cartilage was fixed with sutures and pulled through the vocal cords as previously described by Lawson et al in order to rotate the larynx in a dorsal direction . However, in our hands this did not facilitate the ventral dissection of the larynx. A clamp is then inserted through the tracheostomy into the laryngeal lumen until it can be seen transorally.…”

“…With the growing experience of head and neck surgeons, highly complex surgical procedures, e.g. total laryngectomy, have been performed by TORS . Lawson et al first described the method of robot‐assisted total laryngectomy (TORS‐TL) in 2012.…”

“…Lawson et al first described the method of robot‐assisted total laryngectomy (TORS‐TL) in 2012. Subsequently, they have successfully treated a significant number of patients . Also in 2012, Dowthwaite et al described TORS‐TL in three patients with an indication for oncologic treatment or post‐radiological organ dysfunction .…”

Recent advances in robot‐assisted head and neck surgery

“…nearly 10 years ago , utilization of TORS on the larynx has distinctly progressed. Treatment has already been extended beyond minor malignancies of the vocal cord ; even total laryngectomy has been successfully performed in a considerable number of cases by several institutions . The combination of TORS with a thulium‐YAG laser as a resection modality showed decreased postoperative pain and higher surgical safety when compared with conventional electrocautery in a controlled prospective study .…”