Transoral Robotic Posterior Glottic Scar Lysis and Partial Arytenoidectomy: Report of a Novel Application of TORS for Benign Glottic Surgery

Abstract

Objectives:

Transoral robotic surgery (TORS) for benign glottic conditions is scarcely represented in the literature. We aimed in this study to report on the technical feasibility of an explicitly transoral robotic approach for a patient with posterior glottic stenosis, and to highlight extant limitations in exposure and robotic instrumentation of the glottis.

Methods:

Retrospective chart review of a single patient undergoing a TORS approach to maximize the posterior glottic aperture.

Results:

A 42-year-old female patient with posterior glottic stenosis and a tracheotomy was consented for a robotic posterior glottic scar lysis, KTP-laser assisted partial arytenoidectomy, balloon dilation, and steroid injection. The da Vinci Intuitive Surgical single-port robotic platform was used with 2 robotic arms (needle driver and scissors), and an FK-WO transoral retractor with a straight tongue blade was deployed to facilitate endolaryngeal exposure. KTP laser fiber was passed through a robotic, semi-flexible drop-in guide, and manipulated with the needle driver. Case duration was 40 minutes. There were no perioperative or immediate post-operative complications noted on short-term follow-up.

Conclusion:

We demonstrate technical feasibility and equipoise between an explicitly robotic approach and a standard endoscopic approach to posterior glottic stenosis, a common glottic condition. Further technological development and adaptation of surgical technique are necessary to advance benign robotic laryngeal surgery.