Category: Surgical video - eLarynx

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.

Polyp of the right vocal fold

Tue, 17 Jan 2023 11:41:02 +0100

This is a case of a patient with a polyp located in a posterior part of the right vocal fold. The lesion was held with forceps and then removed with a CO2 laser with scanner mode

Second look cordectomy of the left vocal fold

Tue, 24 Jan 2023 11:40:37 +0100

This is a case showing second look operation in a patient who had a type II cordectomy performed 2 months earlier due to cancer of the left vocal fold reaching the anterior commissure.
Due to the positive superficial margin in the area of the anterior commissure and the close deep margin, the decision was made to perform a second look cordectomy.
Using a CO2 laser scanner, the power of 2 watts, the epithelium, subepithelial layer and part of the muscle were removed step by step. The specimen was sent for histopathological examination.

T2 hypopharyngeal carcinoma

Fri, 09 Dec 2022 13:50:51 +0100

65-year-old, male, T1 suraglottic squamous cell carcinoma, transoral tumorresection using Medrobotics Flex® Robotic System

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.

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.

Resection of eventration of mucosa of the ventricle

Sun, 11 Dec 2022 12:24:59 +0100

In this video we show a case of a patient with eventration of the mucosa of the ventricle, where we performed a laser resection.

Recurrent respiratory papillomatosis RRP

Tue, 24 Jan 2023 11:38:00 +0100

Recurrent respiratory papilllomatosis is the disease cause by HPV viruses typ 6/11. This disease is characterized by recurrent lesions covering the epithelium. This patients has been treated in our Department for 2 years. Last time 6 months ago. Endoscopic examination of the larynx revealed a large papilloma lesion located in the anterior commissure and in the anterior part of the right vocal fold. The papillomas were removed by using co2 laser. During the procedure the biopsy was taken to the histopathological examination. At the end of the procedure a starch dressing was used to prevent adhesions in the anterior commissure area.

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

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.

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.

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.

Leukoplakia of the right vocal fold. Cordectomy type I

Tue, 17 Jan 2023 12:38:16 +0100

This case shows the leukoplakia of the right vocal fold. Cordectomy typ I was performed to excise the lesion. Cotton swab was used to secure the intubation tube. In the first stage, using a laser, we mark the resection margin, then we remove only the epithelium of the vocal fold, preserving the deeper layers, such as the vocal ligament or the vocal muscle.

Tracheostomy under local anesthesia

Sun, 11 Dec 2022 17:06:09 +0100

In this video we show a tracheostomy performed under local anesthesia in a patient with supraglottic cancer. This procedure was done as the first step before proceeding with a supraglottic laryngectomy with CO2 laser and bilateral neck dissection.

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.

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.

Cyst of the vallecula

Wed, 18 Jan 2023 11:09:25 +0100

Cyst of the vallecula 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 using CO2 laser, exposing the cyst capsule, and then, using cold still, the cyst step by step was dissected.

During the dissection of the cyst, it ruptured, but the capsule was preserved, which allowed the lesion to be removed in its entirety.

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.

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.

Right neck dissection levels IIA, IIB, III and IV

Wed, 16 Nov 2022 14:00:22 +0100

In this video we show a neck dissection of the levels IIA, IIB, III and IV.

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. The tissue above the nerve will also be removed in this procedure as the level IIB of the dissection. On the lower limit the omohyoid muscle is identified and preserved, but movilized to be able to remove the tissue below the muscle as the level IV of the dissection. 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.

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

Tumor of the left vocal fold. Cordectomy type II

Tue, 17 Jan 2023 13:51:54 +0100

A 61-year-old man was admitted to the otolaryngology department due to cancer of the left vocal fold. Cordectomy type II was performed.
In the first stage, the resection margin was marked, and then the epithelium and subepithelial layer together with Reinke's space were removed. The specimen was sent for histopathological examination.

Reinke's edema left vocal cord

Fri, 09 Dec 2022 13:18:54 +0100

49-year old female, Reinke´s edema of the left vocal cord, incision of the Reinke´s edema

Reinke's edema of the right vocal cord

Fri, 09 Dec 2022 12:11:46 +0100

47- year old, female, Reinke’s edema of the right side, incision Reinke’s edema right vocal cord using cold steel

Supraglottic cancer TOUSS

Sun, 11 Dec 2022 17:02:51 +0100

In this video we perform a resection of a supraglottic cancer with transoral ultrasonic surgery (TOUSS). The cancer was in the laryngeal surface of the epiglottis. We start cutting at the level of the left aryepiglottic fold and then at the level of the right aryepiglottic fold and we proceed towards the base of the tongue. We circle the entire epiglottis, and we removed the whole tumor with sufficient margins.