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Purpose: This purpose of this case series is to present the first four cases utilizing micro-phonosurgical instrumentation designed specifically for use with a semi-flexible 'robotic' system-the Medrobotics Flex system and to evaluate the accessibility and feasibility of this platform in the context of transoral robotic surgery (TORS) for laryngeal surgery., Methods: Four patients (3 female, 1 male; age range 49-79 years) were operated by the senior author at CHL-a tertiary hospital centre between 2016 and 2017. The 'robot' was deployed in all cases to assess its accessibility and ability to perform surgery in the larynx., Results: All four patients were successfully treated using the system along with newly developed instrumentation specifically focused on phonosurgery., Conclusion: This series has demonstrated accessibility and ability for laryngeal surgery using a novel semi-rigid operator-controlled 'robotic' system. We encountered no device failures and were able to perform all the selected cases uneventfully.

The objective of the study was to determine the etiology and subsequent management of patients with unilateral vocal fold immobility (UVFI) and compare our results with other such studies. This was a retrospective case series of all patients that were treated for UVFI at one single tertiary referral centre between 2010 and 2014. The medical records of 161 patients over a 5-year period diagnosed with UVFI were analyzed. We looked at the patient demographics, side of immobility, etiology, management and voice assessment. A total of 21 patients were excluded due to varying reasons including second presentation and incomplete data. Our results demonstrated 37.1% of cases to be due to non-thyroid surgery (mainly vascular or anterior cervical spine surgery) compared to thyroid or parathyroid (18.6%). Carotid endarterectomy was the commonest cause followed by cervical spine discectomy or fusion. Other iatrogenic causes included thoracic surgery either involving the lung or not. Our results are very much in keeping with those seen by our colleagues in North America. A better appreciation of the causes of UVFI especially in cases not performed by otolaryngologists and head and neck surgeons should be highlighted and the necessary steps should be taken to prevent this iatrogenic complication.

Unlabelled: Type I medialization thyroplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the midline in order to close the glottic gap. One of the challenges of MT is the persistence of symptoms due to incorrect choice of implant size. As of now, no standard objective measure is being used to determine the optimal implant size needed to achieve the glottic closure required. Peak direct subglottic pressure (PDSGP) is one of the aerodynamic objective measurements of vocal efficiency that significantly increases in cases of glottic insufficiency. It is easily measured during MT by inserting a catheter through the cricothyroid membrane. A prospective study was carried out on patients undergoing MT using the Montgomery Implant(®). Choice of implant size was carried out based on the standard perceptual subjective assessment by the operating surgeon and was based on degree of glottic closure and voice quality. PDSGP was recorded for each implant size and then we tested the agreement between the chosen implant size and the lowest PDSGP. The agreement between the implant size of choice and the lowest PDSGP recorded was 62.5 % [CI 44-79 %]. PDSGP was easy to measure and resulted in no complications. PDSGP is a useful tool that could assist in the choice of the correct implant size needed during MT., Level of Evidence: 4.