Celebrating 150 Years of Laryngectomy: Honouring Theodor Billroth's Legacy and Exploring Future Innovations

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5 September 2023

This year, 2023, is the 150th anniversary of the first total laryngectomy. Today it remains the primary surgical solution for people suffering from advanced larynx cancer or as a salvage procedure for patients with recurrent disease after organ preservation.

The first laryngectomy was performed in 1873 by Theodor Billroth. During the surgery, he was able to completely remove an advanced larynx carcinoma and restore the voice by way of an internal artificial larynx.

About Billroth

Billroth was born April 26, 1829, in Bergen on the island Rügen in the former Kingdom of Prussia, now Germany. He considered a career as a pianist, but ultimately decided to study medicine at the University of Greifswald. After completing his medical doctorate at the Frederick William University of Berlin in 1852, Billroth worked as an assistant at the Charité in Berlin in Bernhard von Langenbeck’s surgical clinic from 1853 to 1860. Upon completing his surgical training, he became Director of the surgical hospital and clinic at the University of Zurich. Seven years later he became Professor of Surgery at the University of Vienna and Chief of the Second Surgical Clinic at the Vienna General Hospital. During his time in Vienna, Billroth developed innovative new surgical techniques, which changed the surgical landscape and still resonate today.

About the Billroth Memorial Laryngectomy Conference

To celebrate the 150th anniversary of Total Laryngectomy and in honor of Prof. Dr. Theodor Billroth, a conference will be held at The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, November 23-24 2023.

The conference brings together international experts in the field of laryngectomy, to discuss the development of new surgical techniques, major achievements in post laryngectomy speech and pulmonary rehabilitation, future perspectives of organ preservation therapies and possible benefits of silent speech research.

Delving into Surgery: Insights from Prof. Dr. Michiel van den Brekel

The theme of Surgery will be moderated by Prof. Michiel van den Brekel, Dept of Head & Neck Oncology & Surgery, Netherlands Cancer Institute, Amsterdam.

To get an understanding of what will be presented and discussed during the Surgery part of the conference, here are some highlights from Prof. Michiel van den Brekel.

“Although Billroth described and performed the first laryngectomy and already designed an artificial larynx to rehabilitate the patient, many surgical developments have refined the surgery. As laryngectomy is still a procedure with a high complication rate, frequent recurrences, and functional morbidity, in the presentations we will focus on techniques to prevent complications and manage them,” says Prof. van den Brekel.

Focus of the Surgery lectures will be on:

The optimal techniques for pharynx reconstruction, and how they relate to functional outcomes.
Optimal functional outcomes and surgical refinements to optimise rehabilitation.
How to avoid stoma stenosis and how we manage it.
Can we prevent dysphagia as well as hyper- or hypotonicity?
When is primary TEP possible and when should we perform secondary punctures?

“After this symposium you will be up to date on how to optimally perform this surgery. We will also discuss the indications of laryngectomy and when organ preservation is still an option, either with partial laryngectomy or radiotherapy-based treatments. Different techniques will be discussed. For the future, the role of immunotherapy, possibly replacing surgery, will also be discussed,” says Prof. van den Brekel.

Advancements in Voice Rehabilitation: A Glimpse with Dr. Claudio Parrilla

The theme of Voice Rehabilitation will be moderated by Dr. Claudio Parrilla, Dept of Otolaryngology Head and Neck Surgery, Catholic University of the Sacred Heart and Gemelli Hospital, Rome, Italy.

To get an understanding of what will be presented and discussed during the Voice Rehabilitation part of the conference, here are some highlights from Dr. Claudio Parrilla

“Voice restoration is one of the main challenges for patients undergoing a total laryngectomy. Over the last 30 years, we have witnessed the rise of tracheoesophageal speech which is playing a pivotal role and is currently considered the gold standard of post-laryngectomy voice rehabilitation."

“In comparison with other methods of rehabilitation, we have learned that this technique shows a better maximum phonation time, a higher number of syllables per breath, a greater intensity of sound, and better intelligibility; leading to a more natural sounding voice, superior voice quality, shorter rehabilitation time and a higher success rate (ranging from 60 to 90%). Moreover, the advent of the ‘‘indwelling’’ voice prosthesis as standard in clinical practice, has led to significant improvements in terms of prosthesis lifetime and patient care,” says Dr. Parrilla.

Focus of the Voice Rehabilitation lectures will be on:

New technical insights about voice rehabilitation after total laryngectomy.
Protocols and algorithms about troubleshooting of voice disorders and long-term management of voice prosthesis will be enhanced.
New techniques of second and primary punctures.
The impact of radiotherapy on voice rehabilitation, both in adjuvant and salvage setting.
The prediction, assessment, and management of dysphagia in laryngectomised patients, in salvage setting.
Future perspectives on new materials and tools proposed to obtain regular hands-free speech.

“Despite the better quality of tracheoesophageal voice, 40 percent of laryngectomised patients would tend to speak as little as possible, to leave things unsaid and to use the voice only if there are no other ways to communicate. During the symposium some of the presentations will focus on the importance of holistic rehabilitation after total laryngectomy: managing the emotional and psychological needs to influence the acceptance of the laryngeal voice and the QoL of patients,” says Dr. Parrilla.

The Importance of Pulmonary Rehabilitation: Dr. Richard Dirven Shares his Expertise

The theme of Pulmonary Rehabilitation will be moderated by Dr. Richard Dirven, Dept of Head & Neck Oncology & Surgery, The Netherlands Cancer Institute, Amsterdam.

To get an understanding of what will be presented and discussed during the Pulmonary Rehabilitation part of the conference, here are some highlights from Dr. Richard Dirven.

“Following a laryngectomy, pulmonary problems and having a tracheostoma can have a negative impact on a quality of life and social rehabilitation. In fact, these are often rated as more important than the handicap of voice and swallowing. In the last decade, our knowledge on the physiology of open stoma breathing and the optimal rehabilitation using HMEs has significantly increased. Also, HME performance and stoma attachments with better adhesives has increased compliance. In this conference we will update you on all the latest research and developments and physiologic insights,” says Dr. Dirven.

Focus of the Pulmonary Rehabilitation lectures will be on:

How to optimise post-operative pulmonary rehabilitation
The importance of HMEs for pulmonary function

We hope that these insights will motivate you to register for this unique conference in Amsterdam. We look forward to seeing you there.
Deadline for registration is 15th November, 2023.

More information about the Billroth Memorial Laryngectomy Conference: https://www.hoofdhalskanker.info/professionals/symposia/billroth-laryngectomy-conference/

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