Automatic versus Manual Suturing in Total Laryngectomy: Fistula Incidence, Margin Status, and Operative Time

Area of Science:

• Otolaryngology
• Surgical Oncology
• Medical Devices

Background:

• Pharyngeal reconstruction is a critical step following total laryngectomy.
• Traditional manual suturing (MS) can lead to prolonged operative times and variable outcomes.
• Automatic suturing (AS) offers potential benefits in precision and efficiency.

Purpose of the Study:

• To compare the efficacy and safety of automatic suturing (AS) versus manual suturing (MS) for pharyngeal reconstruction in laryngeal cancer patients undergoing total laryngectomy.
• Key outcomes include pharyngocutaneous fistula (PCF) incidence, operative time, surgical margin status, and hospital stay.

Main Methods:

• A retrospective cohort study included 107 patients with laryngeal carcinoma undergoing total laryngectomy and pharyngeal reconstruction between 2014 and 2024.
• Patients were divided into two groups: AS (n=53) and MS (n=54).
• Data collected included demographics, tumor stage, PCF rates, operative time, margin status, and hospital stay.

Main Results:

• Automatic suturing (AS) was associated with significantly shorter operative times (316.8 vs. 367.2 minutes; p=0.01).
• Negative surgical margins (R0) were achieved more frequently with AS (82.1% vs. 37%; p=0.04).
• Pharyngocutaneous fistula (PCF) rates were higher in the AS group (26.4% vs. 18.5%) but did not reach statistical significance (p=0.328).

Conclusions:

• Automatic suturing (AS) demonstrates potential for reducing operative time and improving negative margin rates in pharyngeal reconstruction after total laryngectomy.
• The observed increase in PCF rates with AS requires careful consideration, potentially influenced by selection bias and anatomical factors.
• Further prospective studies are warranted to validate these findings and optimize AS techniques.