Hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy via transoral robotic surgery

Abstract

Objectives/Hypothesis To describe a hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (hybrid SCPL‐CHEP) combining limited transcervical and transoral robotic approaches. Study Design Preclinical cadaveric study. Methods Using six human cadavers in a series of three preclinical laboratories (July 2016–February 2018), we developed a novel hybrid technique for SCPL‐CHEP. A flexible single‐port robotic surgical system was utilized for the transoral aspects of the procedure. Results Detailed procedural steps are defined: 1) transoral: mucosal incisions under direct visualization of the laryngopharynx (tumor resection); 2) transcervical: incision and mobilization of the larynx and pexis; and 3) transoral: mucosal closure. Hybrid SCPL‐CHEP was technically feasible and allowed for complete transoral mucosal reconstruction. We discuss potential clinical significance of adding this TORS approach to conventional open SCPL‐CHEP. Conclusions This hybrid technique for SCPL‐CHEP provides two main advantages over the standard technique: direct visualization during tumor resection prior to laryngotomy and full closure of the laryngopharynx defect. These technical refinements might facilitate postoperative recovery and in turn make this larynx preservation procedure more accessible to patients and surgeons. A clinical trial evaluating the efficacy of hybrid SCPL‐CHEP appears warranted to validate these observations. Level of Evidence NA Laryngoscope, 129:2065–2070, 2019

Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs

“…Although there is a consensus on standard surgical techniques for OPHLs, the advent of robotic surgery has opened a window on the possibility of performing this surgery using hybrid approaches combining a limited transcervical approach and TORS (93, 94). The hybrid approaches, offering direct visualization during tumor resection before laryngotomy and full closure of the laryngopharynx defect, might facilitate postoperative recovery making this larynx preservation procedure more accessible to patients and surgeons.…”

Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy

“…We recently reported a preclinical study of hybrid SCPL-CHEP by combining limited transcervical approach and TORS. 19…”

“…We recently reported a preclinical study of hybrid SCPL-CHEP by combining limited transcervical approach and TORS. 19 Less-invasive narrow-field access via smaller cervical incision, direct visualization during tumor resection, and full closure of the laryngopharyngeal defect are three advantages of this hybrid approach. Though they stand to be evaluated in the clinical setting, the first and third might facilitate postoperative recovery, and the second allows to place strategic endoscopic cuts to facilitate entry into the larynx from transcervical, so that functional tissue can be preserved.…”

“…After demonstrating the feasibility of hybrid SCPL-CHEP via TORS through three serial preclinical trials (July 2016-Feb 2018), 19 we evaluated the feasibility of a purely endoscopic transoral (EndoT) hybrid SCPL-CHEP without robotics using two fresh-frozen human cadavers in an anatomic surgical laboratory (May 2018).…”

“…Intent on applying MIS concepts to the classical SCPL-CHEP, we described hybrid SCPL-CHEP in a preclinical study that combined a 6-cm limited transcervical approach with TORS. 19 Hybrid SCPL-CHEP offers three advantages over the conventional technique: (1) Less-invasive narrow-field access via smaller cervical incision, (2) direct tumor visualization and mucosal incisions prior to laryngotomy, and (3) full closure of the laryngopharynx defects. The technical refinement of mucosal closure might facilitate postoperative recovery and, in turn, help make this larynx preservation procedure more accessible to patients and surgeons.…”