Transoral videolaryngoscopic surgery of the larynx: Prototype with flexible surgical instruments provides appropriate visualization and accessibility

Introduction Transoral intervention in laryngeal carcinoma is not always possible in both laser microsurgery (TLM) and transoral robotic surgery (TORS) due to difficult exposure and accessibility of laryngeal structures. In patients with insufficient cervical spine reclination, a non-linear surgical system could provide better visualization and accessibility.

Methods The developed prototype of a surgical system for transoral larynx surgery consists of a C-MAC video laryngoscope, a bracket for the operating table and guide tubes for flexible and manually controllable surgical instruments. The system was tested in a user study (n = 6) on an intubation dummy for visualization and accessibility of laryngeal landmarks. The surgeons should display them on the system monitor and touch them with the instrument tip. In a second setup, a vocal cord should be grabbed and manipulated with the second instrument. Photographic documentation and time measurement were carried out.

Results Visualization and accessibility of the laryngeal landmarks were possible at any time. The participants needed an average of 90.7 s (SD = 25.8) in the first round, 49.0 s (SD = 7.6) in the second round. In addition, the subjects were always able to carry out the instrument change independently and put the surgical instruments in the optimal position for excision. The participants needed an average of 127.8 s (SD = 32.3).

Conclusion In pre-clinical tests, the surgical system offers the possibility to manipulate laryngeal structures in a non-linear manner. In the future, this may provide a cost-effective, minimally invasive alternative in case of severe laryngeal exposure.

Poster-PDF A-1089.pdf

Publication History

Article published online:
10 June 2020