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. 2025 Feb;47(2):575-585.
doi: 10.1002/hed.27939. Epub 2024 Sep 26.

Bending the rules: A novel approach to laryngeal surgery in a body donor study

Linus L Kienle  1   2 , Leon R Schild  1   2 , Felix Boehm  1   2 , Viola D Hahn  1   2 , Jens Greve  1   2 , Adrian von Witzleben  1   2 , Thomas K Hoffmann  1   2 , Patrick J Schuler  3
Affiliations

Bending the rules: A novel approach to laryngeal surgery in a body donor study

Linus L Kienle et al. Head Neck. 2025 Feb.

Abstract

Background: Transoral laser microsurgery, the standard surgical approach for early-stage laryngeal cancer, necessitates an unobstructed line of sight to the operating field. However, achieving adequate laryngeal exposure can be challenging, potentially compromising treatment outcomes.

Methods: We developed a 3D-printed curved laryngoscope (sMAC), designed to match the upper airway anatomy. In a user study (n = 15) with a human body donor we compared the sMAC system to conventional microlaryngoscopy regarding laryngeal exposure and accessibility in a difficult exposure scenario.

Results: All 15 participants achieved complete glottic exposure and successfully manipulated laryngeal landmarks using the sMAC system. Only four participants achieved partial exposure using microlaryngoscopy. Positioning of the sMAC system was significantly faster (p = 0.023). A vocal cord resection was conducted successfully (n = 2) using the sMAC system.

Conclusion: The sMAC system effectively addresses challenges associated with transoral laryngeal surgery. Ongoing development aims to overcome current limitations of the system and prepare first clinical trials.

Keywords: 3D‐printing; difficult laryngeal exposure; laryngeal cancer; laryngeal surgery; transoral surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) CAD model of the sMAC laryngoscope. (B) Fully 3D‐printed and assembled sMAC laryngoscope. (C) Control units of monopolar needle instrument (above) and the grasper instrument (below). (D) Tips of the fully flexible surgical instruments inserted into the working channels. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Experimental setup of body donor study. The mobility of the cervical spine and mouth opening was restricted by a cervical support collar. (A, B) The sMAC laryngoscope was attached to the operating table using an articulated stand. The flexible video endoscope was placed into the integrated mount and the endoscopic image displayed on an 18.5‐inch Monitor. (C, D) Kleinsasser operating laryngoscope equipped with a fiberoptic light carrier. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Photographic record of the user study. Endoscopic images of the final position of the sMAC laryngoscope (sMAC) and Kleinsasser operating laryngoscope (OL), respectively, for each participant of the user study. Only study participant No. 4, 5, 12, and 15 were able to expose the posterior parts of the glottic plane using the operating laryngoscope. In contrast all participants successfully visualized the entire glottic plane employing the sMAC system. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Boxplot of the time required for setting up the operating laryngoscope as compared to the sMAC system within each user group. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 5
FIGURE 5
Boxplot of the time required to reach for the predefined laryngeal landmarks with the grasper instrument using the sMAC system for each user group. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 6
FIGURE 6
Resection of the left vocal fold of the body donor using the sMAC system. (A–D) Wedge‐shaped incisions using the DiLumen monopolar needle instrument while tensioning the target area with the grasper instrument. (E, F) Extraction of the removed tissue and close‐up view of the operating field. [Color figure can be viewed at wileyonlinelibrary.com]
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