Stapler-assisted total laryngectomy and hybrid primary puncture: analysis of functional results

Objective. To describe a new surgical technique called Hybrid Primary Puncture in Stapler-assisted Total Laryngectomy and to retrospectively compare two groups of patients undergoing total laryngectomy (TL) with or without the use of stapler. Methods. Retrospective analysis performed on 110 patients undergoing TL and voice prosthesis (VP) primary placement, divided into "stapler group" and "no-stapler group". The two groups were compared in terms of pharyngocutaneous fistula (PCF) incidence and events related to voice rehabilitation (hypertonicity, voice quality, complications related to VP). Results. No statistically significant difference (p > 0.05) was found in "stapler" and "no-stapler" groups analysing the incidence of PCF, the percentages of patients who developed hypertonicity and experienced complications in the use and management of the VP. Regarding the vocal quality, a Quality of Voice index of "good" was found in similar percentages of patients in the two groups. Stratifying the sample, no significant differences emerged between "stapler" vs "no-stapler" in salvage TL in any of the parameters investigated. Conclusions. The new technique allows to exploit, without any additional risk, the potential of stapler and primary VP placement.