Transoral robotic surgery for patients undergoing total laryngectomy: systematic review of current evidence

Background: Transoral robotic surgery (TORS) is an established treatment for oropharyngeal cancer. The use of TORS has extended into performing total laryngectomy (TL) procedures. This systematic review was undertaken to review the feasibility and effectiveness in patients undergoing TORS for TL procedures. Methods: Databases included were PubMed, Embase and Scopus from their inception till the 8th of October 2023. The search strategy included keywords "total laryngectomy" and "transoral robotic surgery" in combination with boolean operators. Inclusion criteria included adults (>18 years old) undergoing TORS for TL, regardless of indication. Studies that evaluated TORS for multiple procedures were only included if they provided a subset data on patients undergoing TL. All study designs including experimental, analytical observational and descriptive observational were considered, regardless of language or country of publication. Two independent authors screened titles, abstracts, and full texts. Critical appraisal was conducted by same reviewers using the JBI critical appraisal tools prior to data extraction. Results: The search identified 182 studies with 122 remaining after duplicates removed. Six studies comprising 42 patients were included in final analysis. Five studies were case series and 1 was a cohort study with a subset population of patients undergoing TL. The main indications for TORS TL included primary or recurrent cancers in 78% of cases and a dysfunctional larynx in 22%. A further 10 cases were either dysfunctional larynx or squamous cell carcinoma but a breakdown was not offered for each category. The mean operative time was 261 minutes. The mean nasogastric tube dependent time was 12.26 days. Postoperative fistulas occurred in 23% of cases and 7% requiring conversion to open surgery. Margins were negative in 14 (of 15) cases where margins were reported. Conclusions: TORS TL offers a feasible minimally invasive treatment option for carefully selected indications. The limited literature identified in this systematic review highlights the indications for this approach and the outcomes with performing this procedure.