Fentex medical has recently launched the revised version of the Laryngeal Advanced Retractor System (LARS). The name is LARS 2.0 (see it at Fentex webpage). The device was originally designed by Marc Remacle*, although he appears to have been marginally involved in the re-design, as it was already built in December 2024 when he answered at my request (“I have been asked indeed to suggest some modifications for the LARS that I designed more than 20 years ago .They should contact me again but they didn’t so far.”).
The original LARS was quite obviously based on the FKWO. Marc Remacle and Georges Lawson were already experts and well known transoral surgeons when they were introduced into TORS by Greg Weinstein. With time, they clearly saw some of the problems with the FKWO. So LARS did not just have the same basic design, but also the same underlying philosophy. Put one and the other side by side and see similitude and differences.
Some of the improvements of the LARS compared the the FKWO are kept in LARS 2.0, even further developed, but it fails to cope with some other basic needs.
The general feeling is of high quality, with a really smooth movement of the articulated parts.
The shape of the frame is “landscape” type to adapt to the the shape of the opened mouth and instruments coming from both sides (FKWO is wider than FW, designed for TLM, but still with a “portrait” appearance). That´s right, but it has no indentation in the lower bar to keep it farther from the mouth. The piece for the upper jaw support (down in surgical position) is detachable, and there area different designs, including specific dental protections. This should help to stabilize the device and it is also important to avoid damaging the patient, because those are aggressive devices.
They have added a handle (the green one) to help positioning the device in the mouth. I am not sure it is helpful. The problem here is that many surgeons hold this devices as a mouth-gag, but they should be held as a laryngoscope. The right technique for the positioning resembles a laryngoscopy (to the left like with a conventional laryngoscope for endotracheal intubation, to the right or in the midline, depending on the particular case and blade used).
And of course it comes with the articulated arm.
There are improvements in the gears. The one for opening is bigger and it should be easier to use (is is really tough in the FKWO). The one to adjust the length of the blades, which is inside the frame, is smaller. This should avoid most of the collisions with the instrument in the right arm, which are frequent with the FKWO.
And I do not know why they insist in the tilt articulation. From our point of view this is useless as it it not possible to adjust it with the pharyngoscope in place.
But the problem is still in the blades. Which is critical. Exposure is everything in transoral surgery. There are two basic issues with the blades:
- The general design. There are some minor details, like the groove at the proximal end (blue arrow). They do have a step between the blade itself and the attachment band, but it is still too low and built in the wrong blades. Adding to the design of the frame, the gear will likely fall disturbing the access. Also, the particular blade shown in the picture should be difficult to place as there is no space for the upper teeth (brown double arrow).
- We have never been able to use this blade in any clinical situation. From our point of view is useless. Still, the LARS 2.0 does not have the TORS blades we need. Is comes just with the blades based on those of the original FK (remember, built for transoral laser microsurgery half a century ago).
However, these are just opinions based on an inspection of the device on a dry environment. Let us give it a try and test it in dissection. We will see and let you know.
J Granell. Feb 8, 2025.
PD. FKWO patent is still active (anticipated expiration is December 9, 2031). But we still need to further work on improving exposure. And the key is how to retract and position the tongue. Working on it.
* Remacle M, Matar N, Lawson G, Bachy V. Laryngeal advanced retractor system: a new retractor for transoral robotic surgery. Otolaryngol Head Neck Surg 2011;145:694-696.
See also: Granell J, Granados J, Fernandez-Rastrilla I, Lopez-Tello H, Haro C, Gutierrez Fonseca R. LARS 2.2 Pharynglaryngoscope: advancing transoral surgical exposure in the post-FKO era. 76 Congreso Nacional de la SEORL-CCC.Madrid, 22-25 oct 2025