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

Pharyngeal reconstruction is essential after total laryngectomy. Traditionally, manual suturing (MS) is used, but it often involves longer operative times and variable outcomes. Over the years, automatic suturing (AS) has gained attention due to its precision, shorter operative time, and lower complication rates.

To compare AS and MS in patients with laryngeal carcinoma who underwent total laryngectomy, focusing on pharyngocutaneous fistula (PCF) incidence, operative time, surgical margins, and hospital stay.

A retrospective cohort from 2014 to 2024 at a tertiary center, including 107 patients with laryngeal carcinoma who underwent pharyngeal reconstruction with AS or MS. The suturing choice depended on oncological safety and surgeon preference. Data on demographics, tumor stage, PCF occurrence, hospital stay, and operative time were collected.

A total of 53 patients underwent AS, and 54, MS. Most were male subjects (96.2%), with similar ages (63.3 versus 62.3 years; p  = 0.559). The PCF rates were higher with AS (26.4 versus 18.5%) but not statistically significant ( p  = 0.328). No correlation was found between salvage laryngectomy and PCF. Negative margins (R0) were more frequently observed in the AS group (82.1 versus 37%; p  = 0.04). Operative time was shorter in AS (316.8 versus 367.2 minutes; p  = 0.01). Hospital stay and time to oral feeding were similar.

There was a noted association between AS and shorter operative time and a higher observed rate of negative margins in selected cases, without an increase in PCF. These findings should be interpreted in the context of selection bias and anatomical constraints.