title: Transoral robotic total laryngectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA. rsmith@montefiore.org
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Schiff
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarta
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hans
authors.forename: Daniel
authors.initials: D
authors.lastname: Brasnu
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*