Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy

Abstract

Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.

Prediction of difficulty in direct laryngoscopy

“…This examination, even though not time-consuming or invasive, constitutes an additional source of radiation exposure for the patient. However, we believe that X-ray assessment could effectively predict the risk of difficult laryngeal exposure; therefore, the surgeon could prepare for this event and prevent laryngeal trauma, incomplete resection or even abortion of the procedure by using different modalities, such as 30° and 70° endoscopes and angular surgical instruments, especially designed for this situation 2 , as well as flexible fibroscopy with two surgeons, as described by Kuang-Chih and Chih-Shin 20 . Therefore, we believe that allowing the surgeon to perform phonosurgery in the best conditions greatly outweighs the disadvantages of ordering a radiographic X-ray.…”

“…This type of procedure promotes the magnification of the image and the possibility of visualizing the endolaryngeal anatomical structures. However, by using rigid laryngoscopes transorally, the view is exclusively frontal in a straight line, which emphasizes the importance of good exposure of the laryngeal structures to properly assess laryngeal lesions and for effective transoral surgery 2 .…”