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Transoral robotic total laryngectomy

Authors

  • Richard V. Smith MD,

    Corresponding author
    1. Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, U.S.A
    • Department of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467
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  • Bradley A. Schiff MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, U.S.A
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  • Catherine Sarta RN,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, U.S.A
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  • Stéphane Hans MD, PhD,

    1. Hopital Europeen Georges Pompidou, AP-HP, University Paris Descartes, Paris, France
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  • Daniel Brasnu MD

    1. Hopital Europeen Georges Pompidou, AP-HP, University Paris Descartes, Paris, France
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Minimally invasive surgery has become the standard of care in many organ systems. Head and neck surgery has incorporated transoral surgery, either laser microsurgery or robotic resection, in the management of pharyngeal and laryngeal cancers. To date, the laryngeal procedures have taken the form of partial laryngectomy, as transoral approaches have not allowed reconstruction following total laryngectomy. We present the first series of transoral total laryngectomies.

Study Design:

Multinational, multi-institutional prospective consecutive case series.

Methods:

Case series of completed and attempted transoral robotic surgery (TORS) total laryngectomy performed under an institutional review board protocol. The procedure was developed in the cadaver laboratory and applied to selected individuals requiring total laryngectomy for recurrent laryngeal cancer or post-therapeutic organ dysfunction.

Results:

TORS total laryngectomy was successfully performed in five patients and was unsuccessful in two others. Two of the patients had postoperative fistulae, and all seven are without evidence of recurrent cancer and are swallowing orally without gastrostomy supplementation.

Conclusions:

TORS total laryngectomy is feasible and can be taught to other surgeons. Potential benefits of this approach are present for patients undergoing salvage laryngectomy and include improved wound healing and functional results. This procedure further extends the applications of robotic head and neck surgery. Laryngoscope, 2013

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