Minimally invasive treatment of laryngoceles: a systematic review and pooled analysis

Laryngoceles are best treated with surgery. The goal of this study is to compare patient outcomes and complications in patients undergoing removal of laryngoceles with either transoral endoscopic/microlaryngoscopic or robotic approaches. A systematic review of the published literature was conducted...

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Bibliographic Details
Published in:Journal of robotic surgery 2022-02, Vol.16 (1), p.1-14
Main Authors: Purnell, Phillip R., Haught, Erica, Turner, Meghan T.
Format: Article
Language:English
Subjects:
Airway management
Case reports
Content analysis
Dysphagia
Dyspnea
Endoscopy
Health services
Hospitals
Humans
Laryngocele - surgery
Laryngoscopy
Length of Stay
Medicine
Medicine & Public Health
Minimally Invasive Surgery
Neck
Ostomy
Review Article
Robotic surgery
Robotic Surgical Procedures - methods
Subgroups
Surgery
Systematic review
Tracheotomy
Tumors
Urology
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Summary:Laryngoceles are best treated with surgery. The goal of this study is to compare patient outcomes and complications in patients undergoing removal of laryngoceles with either transoral endoscopic/microlaryngoscopic or robotic approaches. A systematic review of the published literature was conducted using Pubmed, Web of Science, and the Cochrane Clinical Trials databases. A pooled analysis of individual data was used to compare outcomes between robotic and endoscopic approaches. A total of 30 studies were included. Nine studies with 95 patients were included in the final analysis. Eighty-one (85.26%) were treated with microlaryngoscopic surgery and 14 (14.74%) were treated with robotic-assisted surgery. The rates of tracheostomy (RR = 1.44, 95% CI = 0.389–5.332), complications (RR = 0.329, 95% CI = 0.047–2.294) and recurrence (RR = 0.354, 95% CI = 0.021–5.897) were not statistically different between groups. Within the endoscopic subgroup, 66 laryngoceles (78.57%) were completely excised, while 18 (21.43%) laryngoceles were treated with marsupialization. Marsupialization was associated with an increased risk of recurrence (RR = 4.889, 95% CI = 1.202–19.891). In the robotic subgroup, there was an increased risk of nasogastric tube use (RR = 103.867, 95% CI = 6.379–1619.214) and a longer mean length of hospital stay ( p  = 0.0001). Transoral treatment of laryngoceles has complication and recurrence rates of 18.95% and 7.37%, respectively. Robotic approaches are associated with higher rates of NGT use and increased hospital stay, however much of this is due to one robotic surgeon’s preference for routine NGT placement and higher rates of combined laryngocele removal via robotic approach. Complete excision of combined laryngoceles is possible with transoral approaches. Marsupialization, reported in traditional endoscopic approaches, is associated with a significantly higher rate of recurrence (22.22% vs. 4.76%).
ISSN:1863-2483
1863-2491
DOI:10.1007/s11701-021-01210-x