Patient Care Voice and Airway

Voice and Airway group gets robotic assistance for laryngeal surgery

photo of surgeon at robotics consol
Bharat Panuganti, MD, at the daVinci robotics console performing transoral robotic surgery.

WashU Medicine laryngologist Bharat Panuganti, MD, is expanding the surgical options available to his specialty. The adaption – transoral robotic surgery or TORS – is not new but is rarely used for laryngeal procedures due to the lack of instruments suitable for the size of the larynx.

Panuganti recently used the technique on a patient with posterior glottic stenosis, a narrowing of the airway due to scar tissue caused by prolonged intubation following a motor vehicle accident. The procedure involved a number of steps, including:  scar removal; laser-assisted partial  arytenoidectomy, a cartilage reduction to widen the airway; balloon dilation; and steroid injection.

photo of Bharat Panuganti
Voice and Airway surgeon and Assistant Professor of Otolaryngology Bharat Panuganti, MD.

The procedure lasted a total of only 40 minutes, and the patient was awakened with no post-operative complications.

Panuganti explained the value of the robot to help treat benign conditions of the larynx.

“Current TORS is not specifically designed for the type of precise tissue handling required in microsurgical procedures on the glottis,” he said. “However, the advantages of stability offered by the robotic platform and visualization offered by flexible endoscopy make this a very welcome addition to our surgical arsenal for a number of benign and malignant laryngeal and pharyngeal conditions.”

Panuganti admits further development of the technology are necessary to advance benign robotic laryngeal surgery, but initial successes certainly suggest laryngeal surgery is yet another avenue for growth of robotic surgery.

For Division Chief of Laryngology Molly Huston, MD, the robotic approach offers a new and important surgical option.

“Dr. Panuganti has brought new technology to our surgical service,” she said. “It is creative uses of existing technology that help advance both our surgical abilities and the technology itself.”