eLarynx

Total laryngectomy

Wed, 16 Nov 2022 14:02:50 +0100

In this video we show a total laryngectomy. The most commonly followed incision for total laryngectomy is the U-shaped incision. If possible, the tracheostomy incision is made separately. The subplatysmal flap is raised superiorly above the level of hyoid bone and inferiorly up to the level of the sternum and clavicular heads. We liberate the specimen by sectioning the strap muscles and the omohyoid muscle inferiorly and dettaching the suprahyoid muscles from the hyoid bone superiorly. How the thyroid is dealt with depends on the extent of the tumor. Once the thyroid is out of the way, we continue to separate the tissues from the specimen laterally. We cut the constrictor muscles out of the thyroid cartilage. We then cut the mucosa over the epiglottis and once the epiglottis is identified we grasp it and retract it with the specimen. To avoid cutting through the tumor or its submucosal extension, the pharynx may be entered contralateral to the tumor. Once the extent of the tumor can be assessed through the opened pharynx, we continue to complete the upper limit of the dissection cutting the pharyngeal mucosa. On the lower end, we create the stoma cutting between two tracheal rings and we then separate the trachea and larynx from the esophagus. Once the specimen is out, we carry out the pharyngeal closure, which is a critical step. Finally we end up creating the stoma and closing the entire wound by layers.

Tracheostomy closure

Wed, 16 Nov 2022 13:46:50 +0100

In this video we will show a classic technique for sealing an old tracheostoma that did not close spontaneously.

It is usually a surgery performed under local anesthesia with or without sedation. It is generally divided into three layers: the skin around the tracheostomy, which will be the innermost layer, a layer of fat-fascia-muscle covering the previous suture, and finally, the skin.

There is usually no need to keep a drain after the surgery, and the results of the closure and the aesthetics are good.

Reinke's edema of both vocal folds

Tue, 17 Jan 2023 12:27:11 +0100

A 49-year-old woman was admitted to the clinic because of hoarseness and a low pitch of voice, with long history of smoking. Stroboscopy confirmed a large Reinke's edema of both vocal folds, bigger on the right side. During the operation the epitelium of the left vocal fold was incised using CO2 laser and scissors. Forceps and suction were used to remove the jelly-like secretion from Reinke's space. Excess mucosa was then removed with scissors.

Epiglottic cyst

Fri, 09 Dec 2022 13:38:46 +0100

54-year-old, male, epiglottic cyst, resection of the cyst using Medrobotics Flex® Robotic System

Arytenoid adduction

Sun, 11 Dec 2022 12:30:48 +0100

In this video we show an arytenoid adduction in a patient with a previous medialization thyroplasty. The thyroid cartilage is identified where the thyroplasty prosthesis placed 18 months ago is located. The posterior border of the thyroid cartilage is identified, and the constrictor muscle is cut. The mucosa of the piriform sinus is separated until the arytenoid is palpated. The muscular apophysis of the arytenoid is identified and this area is communicated with the paraglottic space where the prosthesis was (which is now removed). A suture is placed from the muscular apophysis to the anterior part of the thyroid cartilage, and the nod is used to adduct the arytenoid. Finally, a new medialization thyroplasty prosthesis is placed.

Pectoralis Major Myocutaneous Flap

Sun, 11 Dec 2022 16:52:42 +0100

In this video we show how to raise a Pectoralis Major Myocutaneous Flap. An incision is made based on the size of the defect to reconstruct, the pectoralis major muscle is identified and, following the muscle, the flap is raised until the area is fully open, and we have exposed the entire area. The skin of the flap is fixed to the muscle to avoid breaking the perforating vessels. The rib is identified at the most distal end (in this case a small part of the anterior rectus muscle is removed) and the insertions of the pectoralis major muscle on the ribs are cut until the pectoralis minor muscle appears (where the insertions of the pectoralis major muscle end). The pedicle is seen through transparency just on the medial border of the pectoralis minor muscle. Once the pedicle is located, we continue cutting the pectoralis major muscle up to the clavicle and we elevate the flap to the neck.

Type I cordectomy and previous assessment without endotracheal tube

Sun, 11 Dec 2022 13:01:45 +0100

In this video, an assessment with endoscope while the patient is in apnea is performed prior to intubation to thoroughly explore the larynx. This is a patient with a leukoplakia (final pathology: severe dysplasia). Once the endoscopy has been performed, which allows for a very accurate assessment of the larynx, the patient is intubated and direct laryngoscopy is performed. We start the direct laryngoscopy using the endoscope again, to move on to a type I cordectomy with CO2 laser and microscope. Once the cordectomy is finished, the endoscope is used again to better visualize the resection.

Dilation of an idiopathic subglottic stenosis

Wed, 16 Nov 2022 11:12:44 +0100

In this video we are showing a dilation of an idiopathic subglottic stenosis in a 80 years-old woman. We start using a laryngoscope, to first inject corticosteroids into the stenosis. After that, we cut the scar with cold steel and we then proceed with the balloon dilation, with a 15mm balloon. To do the balloon dilation we leave the patient in apnea and we remove the endotracheal tube. After a minute, we intubate again and we re-start ventilation. We repeat this as many times as needed. The results of this case were excellent.

Montgomery T tube replacement

Sun, 11 Dec 2022 13:22:12 +0100

In this video we show the replacement of a Montgomery T tube in a patient with a tracheal stenosis. We remove the old tube, and we intubate the patient. We place a laryngoscope, and we explore the subglottis and trachea with an endoscope. We then ask the anesthesiologist to leave the patient in apnea and we remove the endotracheal tube and place the new Montgomery T tube. Next, we place a Fogarty catheter and we direct it upwards, we inflate the balloon so the anesthesiologist can ventilate the patient without air leak. As soon as the patient breathes spontaneously, the Fogarty is removed and the procedure is finished.

5th European Laryngological Live Surgery Broadcast 2019

Tue, 01 Sep 2020 09:21:06 +0200

Project event E1

5th European Laryngological Live Surgery Broadcast 2019

2019-11-27

Resection of a chondroma of the thyroid cartilage

Sun, 11 Dec 2022 12:59:59 +0100

In this video we show how to resect a chondroma of the thyroid cartilage. The larynx and the thyroid cartilage are exposed. The constrictor muscle is sectioned. The cartilage is rotated and exposed to see the tumor on the external side. The cartilage is sectioned with a saw anterior to where the tumor is located. The tumor is separated from the piriform sinus and the paraglottic space. The inferior horn of the thyroid is disarticulated. Finally, the tumor is removed. The constrictor muscle is sutured to the infrahyoid muscles. A drain is left, and we close by layers.

Tumor of the left vocal fold. Cordectomy type V

Wed, 18 Jan 2023 10:55:58 +0100

A 68-year-old male was admitted to the otolaryngology department due to a tumor of the left vocal fold. T2 N0M0. Stroboscope examination showed a tumor infiltrating the entire left vocal fold, anterior commissure and penetrating to the subglottic area. In the computer tomography examination the infiltration of the laryngeal cartilages was not noticed. therefore, a decision was made to perform endoscopic surgery. Type V cordectomy was performed due to the extent of the tumor.
In the first stage of the operation, the left vestibular fold was removed to better visualize the lesion. Then, the soft tissues of the anterior commissure were separated from the thyroid cartilage using a CO2 laser and forceps. Step by step the entire vocal fold was removed, preserving the anatomical structures. During such an extensive resection, a monopolar electrode was used to coagulate bleeding vessels.

Pharyngeal reconstruction with pectoralis major myocutaneous flap

Sun, 11 Dec 2022 16:55:06 +0100

In this video we show a Fabian-type circular pharyngectomy closure with a split-thickness skin graft on the posterior wall and a horseshoe-shaped pectoralis major myocutaneous flap. In some cases where it is not possible to do a free flap, the pectoralis major flap with a split-thickness skin graft can be used to make a new pharynx. This video shows this technique. The split-thickness skin graft has been placed on the prevertebral wall, along with a salivary bypass tube. A pectoralis major myocutaneous flap is raised to close the pharynx. The skin of the pectoralis major myocutaneous flap is sutured to the esophagus at the lateral level. The proximal skin of the flap is sutured to the posterior wall of the theoretical pharynx, taking prevertebral muscles and the split-thickness skin graft. The flap is sutured at the base of the tongue. Finally, the remaining wall is sutured. It is reinforced by suturing the pectoralis muscle to the suprahyoid muscles.

Posterior cordotomy due to glottic stenosis

Fri, 09 Dec 2022 12:27:41 +0100

64-year old, female, bilateral vocal cord paralysis, posterior cordotomy (Kashima) with laser

Endoscopic marsupialization of a Zenker´s diverticulum

Wed, 16 Nov 2022 11:54:03 +0100

In this video, we show the marsupialization of a Zenker´s diverticulum through an endoscopic approach using CO2 laser. We start by introducing the endoscope until we localize the diverticulum. We then cut the crycopharyngeal muscle with laser, which is the origin of the problem. As soon as the muscle ends, we stop cutting due to the risk of a fistula.

Total laryngectomy with Endo GIA closure

Sun, 11 Dec 2022 13:10:13 +0100

In this video we show a total laryngectomy performed with the surgeon on the left side in a patient with a T4a larynx cancer. A left hemithyroidectomy was also performed as part of the oncologic surgery. The closure was done using an Endo GIA.

Vestibular fold cyst

Tue, 17 Jan 2023 12:08:34 +0100

Vestibular fold cyst can be removed using cold still or CO2 laser. In this case, both of these tools were used. First, the epithelium of the vestibular fold was incised, exposing the cyst capsule, and then, using cold still, the cyst was dissected.

Cordectomy type III of the left vocal cord

Fri, 09 Dec 2022 12:21:34 +0100

65-year old, male, pT1 squamous cell carcinoma of the left vocal cord, Laser cordectomy type III

Laryngeal papillomatosis vaporized with blue laser

Sun, 11 Dec 2022 12:55:18 +0100

In this video we show a patient with recurrent papillomatosis of the larynx, operated multiple times, who in this case is operated using the blue laser to better reach the lesion, which is located posteriorly, at the level of the vocal process of the right arytenoid. The result was very good.

Cordectomy type III right vocal cord

Fri, 09 Dec 2022 12:47:16 +0100

69 year old, male, pT1a squamous cell carcinoma of the right vocal cord, cordectomy type III, laser

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:40:49 +0100

60 year old female patients with RRP.
A 60-year-old woman, a teacher of Polish literature, suffering from recurrent papillomatosis of the larynx for several years. The stroboscopy revealed a lesion on the laryngeal surface of the epiglottis. Due to the difficult location, the lesion was removed using a microdebrider with a suction function. During the procedure, the epiglottis was held with forceps.

Cordectomy II left vocal cord

Fri, 09 Dec 2022 13:17:01 +0100

Male, 65 year- old, pT1 squamous cell carcinoma of the left vocal cord, cordectomy type III, laser

Right neck dissection levels IIA, III and IV in the context of a salvage total laryngectomy

Wed, 16 Nov 2022 13:57:01 +0100

In this video we show a neck dissection of the ipsilateral levels IIA, III and IV in the context of an N0 laryngeal cancer that it is undergoing a salvage total laryngectomy.

Different incisions can be done, but in this case we used the same incision we later used for the total laryngectomy, which it is a separate incision from the tracheostomy.

After cutting the skin, subplatismal flaps are raised. Then, the anterior border of the SCM muscle is identified and the fascia cut. The SCM muscle is skeletonized and the internal jugular vein is exposed. The XI cranial nerve (accessory nerve) is located in the upper third of the SCM muscle. On the lower limit the omohyoid muscle is identified. The upper and lower ends of the internal jugular vein are identified and all the tissue on top of the vein is removed. The cervical rootlets are sought, preserved and followed, protecting the scalenes and the phrenic nerve at the floor of the neck.

Subepithelial cordectomy right vocal cord

Fri, 09 Dec 2022 13:30:29 +0100

48-year old, male, cyst of the right vocal cord, cordectomy type I (subepithelial) right side

Type I cordectomy with cold steal instruments

Sun, 11 Dec 2022 12:33:37 +0100

In this video we show the resection (excisional biopsy) using cold steal instruments in an old patient with comorbidities. We performed a limited type I cordectomy to get a final diagnosis. It combines assessment with endoscopes and with the microscope.