Surgery performed by Dr. José Granell
In the field of head and neck oncologic surgery, the evolution toward minimally invasive techniques has been dizzying in recent years. A clear example of this transformation is the work of our newest addition to the panel of experts at the app SurgSchool, the Dr. José Granell, otolaryngologist at the HLA Moncloa University Hospital in Madrid, Spain, who has established himself as an international benchmark in transoral robotic surgery (TORS) applied to laryngeal and pharyngeal tumors.
In this case uploaded to SurgSchool, Dr. Granell guides us through a supraglottic horizontal partial laryngectomy performed with robotic assistance, a technique that combines classical anatomical foundations with the millimetric precision of robotics to achieve effective and conservative oncological resection.
Surgical fundamentals and advantages of the robotic approach
This technique is based on the anatomical and oncological description of the compartmental larynx, originally developed for the transoral laser microsurgery (TLM)However, robotic surgery introduces key advantages:
- Greater bimanual precision in narrow spaces.
- resections in monobloc, facilitating pathological analysis.
- Unmatched three-dimensional visualization and instrument stability.
These features allow the surgeon to achieve a complete and safe resection, even in cases with complex anatomy or demanding oncological margins.
Step by step of the surgical technique
- Start of resection:
The intervention begins at the boundary between the vallecula and base of the tongue, using as an anatomical reference the hyoid boneThis delimitation ensures that the preepiglottic space be included in the surgical block. - Lower progression:
It is identified thyrohyoid membrane, continuing towards the upper border of the thyroid cartilageThe incision of the perichondrium and its internal subperichondrical dissection are performed with bimanual precision, a maneuver impossible to achieve with TLM. - Symmetrical dissection:
Once the dissection is completed on the right side, the technique is reproduced on the left, achieving symmetry and complete release of the preepiglottic space. - Control of pedicles and folds:
The following are addressed: pharyngoepiglottic and aryepiglottic folds, with special attention to superior laryngeal pedicle, which must be carefully dissected and monitored to prevent postoperative bleeding. Advanced coagulation systems such as bipolar, clips, or even ultrasonic energy (harmonic) are used, depending on the vessel's caliber. - Tumor resection:
The section includes the ventricular band to the laryngeal ventricle, without compromising the true vocal cordsThe arytenoid cartilage is preserved if oncologically possible, helping to preserve phonatory and swallowing functions. - Removing the part:
Once the resection is complete, the specimen is carefully removed. The macroscopic limits and, if necessary, frozen biopsies are taken to ensure negative margins.
Indications, safety and functional results
La robotic supraglottic laryngectomy It is indicated for tumors located in the supraglottis without invasion of the vocal cords or cricoid cartilage. The main clinical advantages include:
- Reduction of permanent tracheostomies.
- Better conservation of the phonatory and swallowing function.
- Shorter hospital stays and faster recovery.
However, one of the most critical risks is the postoperative hemorrhage, which requires a meticulous intraoperative hemostatic technique and intensive follow-up in the first 48-72 hours.
En SurgSchoolWe continue to bring these cutting-edge procedures to the global surgical community. This intervention is not only a flawless technical example, but also a demonstration of the transformative potential of robotics in head and neck surgery.
