The First Laryngectomy

First total laryngectomy by Theodor Billroth was 150 years ago.

On December 31, 1873, in the Vienna surgery clinic, the German surgeon Theodor Billroth managed what no previous surgeon had been able to: complete ablation of the larynx in a human being, which quickly came to be known as “total laryngectomy”, without harmful immediate consequences.

Billroth dared what none before had done. He had come to the conclusion that “the only way of saving life was to remove the entire larynx.”

The patient was a 36 year old man with a subglottic squamous cell carcinoma. On November 27, 1873 Billroth performed a partial laryngectomy. Subsequent laryngoscopic examination in mid-December 1873 found tumor recurrence. On December 31, 1873 Billroth performed the first total laryngectomy.

The patient recovered, and an artificial larynx was manufactured for him which enabled the patient to speak despite the removal of his vocal cords.

This first total ablation of the larynx, preceded by a tracheotomy, was one of the great surprises of 19th century surgery.

This was possible because of the prior experimental study of laryngeal ablation performed in dogs by Vincent Czerny. The French physician Henri Chouppe enthused: “when experimental studies lead to practical results, one should hasten to do It”.

Older references credit a Patrick Watson of Edinburgh with the first laryngectomy in 1866, but this patient’s larynx was only excised after death.

Also…

The first artificial larynx was constructed by Johann Nepomuk Czermak in 1869. Vincenz Czerny developed an artificial larynx which he tested in dogs in 1870.