Simplified keel insertion after transoral laser cordectomy in early glottic cancer: a practical approach

Abstract Aim To describe the feasibility and safety of a simplified technique for endoscopic keel placement and removal following transoral laser cordectomy involving the anterior commissure, and to report preliminary outcomes related to anterior glottic web prevention. Methods This prospective study included five patients with early glottic cancer undergoing transoral laser cordectomy involving the anterior commissure. A silicone keel was placed endoscopically using a modified fixation technique. Keel removal was performed under local anaesthesia at 4 weeks postoperatively using flexible laryngoscopy. Patients were followed with serial laryngoscopic examinations and voice assessment using the Voice Handicap Index‑10 (VHI‑10). Results Keel placement and removal were successfully completed in all patients without intraoperative or postoperative complications. No cases of anterior glottic web formation were observed during follow‑up. The mean postoperative VHI‑10 score was 28.5 ± 12.5, indicating a moderate subjective voice handicap. Conclusion This study demonstrates the feasibility and safety of a simplified endoscopic keel placement technique with removal under local anaesthesia in a small cohort. The findings are preliminary and suggest potential benefit in preventing anterior web formation with acceptable subjective voice outcomes. Larger prospective studies are required to validate efficacy and functional results.