A woman in France is beginning to apeak again more than two decades after receiving the first successful larynx transplant in France, at a hospital in Lyon (Rhône).
Karine, 49, a former care worker, lost the use of her larynx 23 years ago after an injury. She is now finding her voice again after a successful larynx transplant at the start of September this year (2023).
The transplant is the first of its kind in France, and was completed by a large team of ear, nose, and throat (ENT) specialists at the Croix-Rousse hospital.
Karine told France 3: “I don’t really like my voice. I think it’s too deep. But, well, I’m managing.”
Dr Pierre Philouze, one of her surgeons, said: “That’s normal. The operation was only two months ago, and the vocal cords of the new larynx have just been positioned in a closed position. You will continue to improve, and we can already hear your southern accent coming through!”
Donor surgery
The donor larynx came from a woman who had been pronounced brain-dead, and her family gave consent for her organs to be used for transplants.
The larynx was taken by a team led by Professor Sébastien Vergez, an ENT surgeon at the CHU Toulouse (Haute-Garonne). This process took eight hours, as the team had to work on not only the 12cm-long larynx, but also the veins and arteries that supply the organ with blood, and the nerves that allow it to function.
They had to carefully identify and label every single nerve, vein, and artery, to allow the transplant surgeons to reattach them correctly in Karine’s body.
Read more: Organ donation in France: Why it is good to talk about it
27 hours of surgery
Pour la 1re fois en France, un larynx a été greffé !
Félicitations à toutes les équipes mobilisées :
- 12 chirurgiens et chirurgiennes multi–spécialisés, dont 6 de la #TeamHCL et 6 d'autres hôpitaux français : @CHURennes, @CHUnantes @ChudeToulouse, @HopitalTenon @CHURouen,… pic.twitter.com/oRD1v5kzcH
— HCL - Hospices Civils de Lyon (@CHUdeLyon) November 20, 2023
The transplant surgery then began at the Croix-Rousse hospital towards 23:00, with a team of 10-12 surgeons working on Karine at any given moment over 27 hours.
Specialists for each part stepped in at the correct time. Surgeons came from Toulouse, Rennes (Ille-et-Vilaine), Nantes (Loire-Atlantique), Rouen (Seine-Maritime), and Paris.
“My speciality is nerves," said Professor Jean-Paul Marie, head of the ENT department at Rouen University Hospital.
“For years, I've been working on laryngeal reinnervation: my role has been to locate and identify the different nerves. Those that are more 'motor' or 'sensory'. They need to be properly reconnected if we are to have a perfectly functional larynx in the future.”
Professor Bertrand Baujat, head of the ENT department at Hôpital Tenon in Paris, and his Parisian colleague, Professor Sébastien Albert, performed the vascular reconnections.
They said: “We worked in microsurgery throughout the night, because we were reconnecting vessels that are between 2 and 3 millimetres in diameter, maximum.”
Professor Philippe Céruse, head of the ENT department at the Croix-Rousse hospital, coordinated the entire operation. He said: "There are 10 of us ENT surgeons working on this project.”
A first for France
Prof Céruse explained how rare the operation is, saying: “There have been very few documented and scientifically validated larynx transplants in the world.
“We have been preparing this delicate operation for 10 years. We had a patient who was willing to undergo the operation and regain her voice; all we were waiting for was a compatible donor.”
He congratulated the team, and said: “It'# has been a marathon operation, a total of nearly 27 hours in the operating theatre…We managed it because we all took it in turns... It was extraordinary teamwork!”
He said there have been 11 documented and validated cases worldwide.
Learning to talk again
Karine now faces a long road of rehabilitation, including daily exercises to help her ‘relearn’ how to breathe, speak, and swallow with her ‘new throat’.
She still uses a cannula through a tracheotomy (a tube into her throat) to help her breathe while the new larynx becomes fully operational. Her voice is still very laboured, but it will improve, specialists say.
She is working with Croix-Rousse physiotherapists, and speech therapist Nathalie Crouzet, who explained: “For now, it is still very mechanical. She has to get to grips with it, and the neurological controls have to work. All the equipment is there, but it is not completely hers yet.
“Neurologically, it will "grow back" and the organ will become hers. She will learn to tame it.”
Karine is now back home living with her family. Eventually, the aim is that she will be able to speak in a voice that is close to her original sound, said Prof Céruse to FranceInfo.
She will also eventually be able to breathe and swallow unaided as well, and even rediscover scents that she could not smell before.
Prof Céruse has now said that “we have the green light and budget” for three more larynx transplants, but the team will wait for progress reports from Karine before “continuing with other interventions”, he said.
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