From concept to clinical reality: implementing tracheal autotransplantation in conservation laryngectomy

The implementation of tracheal autotransplantation in conservation laryngectomy is an illustration of how surgical research on laryngotracheal reconstruction was taken from the bedside to the laboratory and back. The study started in 1989 in an effort to improve laryngeal reconstructive methods because a total laryngectomy seemed unnecessary radical for unilateral fixed-cord glottic lesions. The clinical problem we chose for investigation was taken to the laboratory and a rabbit model allowing tracheal revascularization and transplantation was developed. Different steps in surgical research resulted in a reconstructive method for hemicricolaryngectomy defects. The reconstruction consist of revascularized pathes of cervical trachea which may be autotransplanted to the larynx. After experimental evaluation, tracheal autotransplantation was applied clinically in the functional treatment of laryngeal cancer necessitating a resection of the cricoid cartilage. The first patient was treated in 1996 and 25 patients were treated in a 3 years period. It is estimated that 25% of the currently performed total laryngectomies may be considered for organ saving through tracheal autotransplantation.