Laser-Assisted Transoral Robotic Supraglottic Laryngectomy
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Updated: Nov 1, 2026
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Published on: October 24, 2025
Nir Tsur1, Andrea Costantino2, J Scott Magnuson1
1Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, Orlando, Florida, USA.
Objective:
To describe the operative setup, safety principles, and stepwise technique for laser-assisted transoral robotic supraglottic laryngectomy using a flexible CO2 laser system.
Methods:
This operative video demonstrates laser-assisted transoral robotic supraglottic laryngectomy performed with the da Vinci SP platform. Key technical steps include laser-safe airway management, transoral exposure with a Feyh-Kastenbauer retractor, robotic docking, flexible CO2 laser fiber placement through a distal drop-in guide, aiming-beam confirmation, noncontact laser dissection, coordinated bedside suction and bipolar hemostasis, and en bloc specimen delivery.
Results:
The technique allows controlled transoral access to the supraglottic larynx with three-dimensional visualization, precise noncontact laser incision, and preservation of uninvolved glottic and subglottic structures. A deliberate sequence of inferior, lateral, and superior release facilitates exposure of the pre-epiglottic space, specimen mobilization, and margin-oriented en bloc resection.
Conclusion:
Laser-assisted transoral robotic supraglottic laryngectomy combines the precision of CO2 laser surgery with the visualization and dexterity of single-port robotic surgery. With appropriate patient selection, strict laser safety, and a standardized team-based workflow, this technique can support precise en bloc resection, reliable margin assessment, and preservation of uninvolved laryngeal structures.
