Transoral robotic surgery total laryngectomy

Transoral Robotic Surgery Total Laryngectomy: Evaluation of Functional and Survival Outcomes in a Retrospective Case Series at a Single Institution

“…This is a technically less demanding closure than previously described T-shaped closure techniques [14] and theoretically reduces the risks of pharyngeal shelf and neopharyngeal diverticula formation with associated poor swallowing outcomes [15]. All senior authors reporting on TORS-TL close the pharyngotomy in a horizontal orientation, with Lawson et al [9] also applying fibrin glue over the incision for watertight closure. No previously published TORS-TL case series have reported complications of neopharyngeal diverticula formation.…”

“…Lawson et al [9], Smith et al [10], and Smith [12] described TORS-TL in detail. Our description of TORS-TL follows a similar pattern to those previously described, with cervical dissection followed by transoral robotic resection and then pharyngotomy reconstruction and cervical closure.…”

“…Our description of TORS-TL follows a similar pattern to those previously described, with cervical dissection followed by transoral robotic resection and then pharyngotomy reconstruction and cervical closure. Lawson et al [9] incorporated a distinguishing step in their operative description, which is that during cervical dissection, heavy braided sutures are placed around the lateral walls of the rostral trachea and then threaded through the glottis, to allow intraoral retraction of the larynx during the robotic dissection. When the larynx is completely mobilised, these sutures give rostral pull to the inferior portion of the laryngeal skeleton, aiding its delivery through the mouth.…”

“…TORS total laryngectomy (TORS-TL) has previously been described [9,10,11,12], and has been met with scepticism as to its ultimate clinical benefit. This is because the overwhelming majority of patients requiring total laryngectomy have laryngeal SCC as the indication for surgery and this usually requires a concomitant bilateral neck dissection, largely obviating the usefulness of a minimally invasive approach to the primary site.…”

Letter to the Editor regarding “Robotic or non‐robotic transoral laryngectomy”

“…1 The article points out further potentialities brought by robotics and serves to highlight the fact that radical surgery might also benefit from minimal approaches. Lawson et al 2 were the first to describe transoral total laryngectomy with a previous robotic system. The procedure requires that a new stoma is created (the tracheostomy), and, thus, it is necessarily not totally transoral but a hybrid procedure, with a percutaneous transcervical component.…”