title: Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.
abstract: BACKGROUND
  Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented.
  
  
  METHODS
  TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail.
  
  
  RESULTS
  Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures.
  
  
  CONCLUSIONS
  Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Schuler
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Veit
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotter
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Friedrich
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Greve
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Scheithauer
mesh_terms: D000368:Aged; D002102:Cadaver; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D007830:Larynx / Q000473:pathology* / Q000601:surgery*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: TORS; camera; flex; robot-assisted; total laryngectomy