title: Transoral ultrasonic total laryngectomy (TOUSS-TL): description of a new endoscopic approach and report of two cases.
abstract: The minimally invasive total laryngectomy avoids a wide surgical field and so it has the potential benefit of reducing the local morbidity, especially on radiated patients. This approach has been previously described on a robotic basis, the transoral robotic total laryngectomy (TORS-TL). We have designed a minimally invasive approach for total laryngectomy (TL) using the transoral ultrasonic surgery technique (TOUSS). TOUSS is a transoral, endoscopic, non-robotic approach for laryngeal and pharyngeal tumors, based on the ultrasonic scalpel as a resection tool. Two patients with a laryngeal squamous cell carcinoma with indication for total laryngectomy were surgically treated: one primary TL for a subglottic carcinoma and one salvage TL with partial pharyngectomy for a local relapse after chemoradiotherapy of a glottic carcinoma. The tumors were completely removed with free surgical margin in both patients. The functional recovery was satisfactory in terms of swallowing and speech (a tracheoesophageal puncture and voice prosthesis placement were done in the same procedure). No intraoperative complications were observed. The patient with previous chemoradiotherapy had a pharyngocutaneous fistula which closed spontaneously without additional surgery. We have demonstrated that transoral endoscopic approach to the larynx and pharynx is feasible without a robotic platform. TOUSS-TL can easily spread the transoral endoscopic philosophy as well as the benefits of a minimally invasive way to remove the entire larynx. Further research will show the advantages in terms of complications and functional outcomes.
authors.affiliation: Department of Otorhinolaringology, Henares University Hospital, c/Marqués de Lozoya no 3-escC-9oB, 28007, Coslada, Madrid, Spain. mmarcos.fernandezf@salud.madrid.org.|Hospital Universitario del Henares, Servicio de Otorrinolaringología, Avda Marie Curie s/n, 28822, Coslada, Madrid, Spain. mmarcos.fernandezf@salud.madrid.org.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Fernández-Fernández
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center Madrid, c/Arturo Soria 270, 28033, Madrid, Spain.
authors.forename: Lourdes Montes-Jovellar
authors.initials: LM
authors.lastname: González
authors.affiliation: Department of Otorhinolaringology, VITHAS Nuestra Señora de América Hospital, c/Arturo Soria 103, 28033, Madrid, Spain.
authors.forename: Carlos Ramírez
authors.initials: CR
authors.lastname: Calvo
authors.affiliation: Department of Otorhinolaringology, Complexo Hospitalario Universitario de A Coruña, c/As Xubias 84, 15006, A Coruña, Spain.
authors.forename: Pablo Parente
authors.initials: PP
authors.lastname: Arias
authors.affiliation: Anatomy and Neuroscience Department, Autonoma University Medical School, Madrid, Spain.
authors.forename: Francisco Clascá
authors.initials: FC
authors.lastname: Cabré
authors.affiliation: Department of Otorhinolaringology, Mostoles University, c/Río Júcar s/n, 28935, Móstoles, Madrid, Spain.
authors.forename: Primitivo Ortega
authors.initials: PO
authors.lastname: Del Álamo
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*; D059708:Ultrasonic Surgical Procedures / Q000379:methods*
keywords: Minimally invasive surgery; TORS; TOUSS; Total laryngectomy; Transoral robotic surgery; Transoral surgery