Revisiting the closed stapler laryngectomy: Technique and review of recent evidence

Objective: To review the current literature regarding stapler-assisted closed total laryngectomy (TL), present a case series, and provide details on operative technique.

Finding: Several meta-analyses and randomized controlled trials have demonstrated lower rates of pharyngocutaneous fistula (PCF) with closed stapler-assisted TL compared to traditional manual closure. Operative time, hospital stay, and time to oral feeding also appear to be lower. We present a five-patient case series of stapler-assisted closed TL with successful outcomes, including the first reported salvage case with free flap reconstruction, and provide technical detail including intraoperative photographs.

Conclusion: Stapler-assisted closed TL appears to be a safe alternative to traditional manual closure in select patients with endolaryngeal tumors with potential for lower rates of PCF and shorter operative time, hospital stay, and time to oral feeding.