1. The Role of Lasers in Benign Laryngeal Surgery
Vyas M.N. Prasad MSc FRCS(ORL-HNS), Ramon Franco MD, Marc Remacle MD PhD
Ng Teng Fong Campus, National University Health System, Singapore - Massachusetts Eye and Ear, Harvard Medical School, USA
CHL, Eich, Luxembourg
INTRODUCTION: The use of lasers in the larynx has been well described over the last forty years. However, there is still controversy and uncertainty of the safety and versatility of lasers in microphonosurgical work. Lasers have traditionally been used for oncological work with great success (Steiner, Ambrosch). We present a synopsis of the use of lasers in benign laryngeal surgery from a European, Asian and North American perspective and the aerodynamic assessments. will enjoy this instructional course.
HISTORY OF LASERS IN LARYNGOLOGY
LASERS
CO2 LASERS
Since Einstein’s original postulation of light amplification by stimulated emission of radiation, lasers have over the last four decades permeated nearly every facet of modern human life. Following on from the microwave based MASER, the solid-state ruby laser and thereafter a gas based carbon dioxide (CO2) laser were invented by Maiman and Patel respectively. The latter has become the workhorse laser for ENT surgeons given its preferential absorption by water and low thermal side-effects. Despite the perceived notion that lasers are suitable for more aggressive laryngeal surgery such as treatment of cancer, the technology has progressed steadily to be able to successfully treat many benign laryngeal conditions with equal if not better results compared to traditional cold steel or open methods.
Lesions amenable:
Cysts
Polyps
Nodules
Vocal fold granuloma
Laryngocoeles
Leukoplakia
Sulcus
Glottoplasty – pitch raising
Scanning technology benefits:
Adjustable shape
Depth of penetration
Single, repeat or continuous
Minimal thermal injury
Minimal absorption into Reinke’s space
Minimal scarring
Good voice results
OFFICE BASED FIBRE LASERS
Diode laser
TYPES OF LASERS
Lumenis CO2 Duo laser
KTP Thulium
Diode CO2 Waveguide
PDL PIRL
Carbon Dioxide Laser (CO2) – 10600nm
High water absorption
Articulated arm and fibre delivery systems
Scanning technology (e.g. Lumenis)
Potassium titanyl phosphate (KTP) laser – 532nm
Pulsed angiolytic laser – vascular lesions, papillomatosis and dysplasias
Fibre delivery, non-contact, Office- based use possible
Enhanced haemostasis
Pulsed-dyed laseer (PDL) – 585nm
Photo-angiolytic laser – no-touch laser
More prone to vessel wall rupture (shorter pulse width)
Office-based use possible
Thulium laser – 2013nm
Chromophore – water
Diode-pumped solid state laser
Fibre delivery – tangential dissection
DISCUSSION & CONCLUSION
A variety of lasers have been developed and used successfully in benign laryngeal surgery. The misconception of lasers being hazardous to the integrity and function of the delicate vocal fold has been refuted by a several laryngologists worldwide (ref: Remacle, Ramon, Hess, Zeitels). Opinion is divided as to the type of laser that is preferred for certain pathologies such as vascular lesions and papillomatosis. The CO2 scanning system has shown great promise in delicate phonosurgical work with excellent post-operative voice results. Similarly, the use of photo-angiolytic fibre lasers especially in the office have demonstrated the safety, versatility and success of such systems.
It is our opinion that a thorough understanding of laser physics, tissue physiology, meticulous surgical skill and judicious user of lasers for benign laryngeal lesions can obviate the need for cold steel techniques that may bleed and open techniques which can have added morbidity.
Micromanipulator CO2 laser
Scanner piece
Wendler glottoplasty
CO2 laser intracordal cyst