Hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy via transoral robotic surgery.

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.