Office Laser Laryngology: A Paradigm Shift

Hantzakos, Anastasios G; Khan, Mumtaz

doi:10.1177/0145561320930648

Cited by 10 publications

(13 citation statements)

References 16 publications

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“…A wide range of laryngological diseases are amenable to TNFLS, including telangiectasia, RRP, polyps, granulomas, and biopsy, when patients are not suitable for general anesthesia. 5 Although specific data on blue laser are limited to cases performed under general anesthesia, 9 in the authors' experience, office blue laser TNFLS is both efficacious and safe in all of the above applications.…”

Section: Case Selectionmentioning

confidence: 91%

“…1,2 A multitude of benefits are well established, primarily relating to minimized morbidity, patient inconvenience, and associated costs of theater-based surgery under general anesthesia. [3][4][5] A range of lasers are currently used in TNFLS, primarily photoangiolytic varieties such as the 585 nm pulsed-dye laser (PDL) 1,6 and the 532 nm potassium titanyl phosphate (KTP) laser, 7 the latter being the most widely studied and utilized. 7 The use of cutting lasers such as the 10 600 nm CO 2 laser 8 remains limited in the office setting due to its comparatively expensive flexible glass fibers and poorer coagulation profile.…”

Section: Introductionmentioning

confidence: 99%

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Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

2020

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Background: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. Objectives: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. Methods: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. Results: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia ( P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. Conclusions: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.

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Section: Case Selectionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

2020

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“…In-office surgery is an increasingly attractive option for the treatment of many benign and pre-malignant tumors of the voice box [1]- [3]. These procedures are performed as illustrated in Fig.…”

Section: Introductionmentioning

confidence: 99%

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Chiluisa¹,

Pacheco²,

Do³

et al. 2022

Preprint

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This paper reports the design, construction, and experimental validation of a novel hand-held robot for inoffice laser surgery of the vocal folds. In-office endoscopic laser surgery is an emerging trend in Laryngology: It promises to deliver the same patient outcomes of traditional surgical treatment (i.e., in the operating room), at a fraction of the cost. Unfortunately, office procedures can be challenging to perform; the optical fibers used for laser delivery can only emit light forward in a line-of-sight fashion, which severely limits anatomical access. The robot we present in this paper aims to overcome these challenges. The end effector of the robot is a steerable laser fiber, created through the combination of a thin optical fiber ( 0.225 mm) with a tendon-actuated Nickel-Titanium notched sheath that provides bending. This device can be seamlessly used with most commercially available endoscopes, as it is sufficiently small ( 1.1 mm) to pass through a working channel. To control the fiber, we propose a compact actuation unit that can be mounted on top of the endoscope handle, so that, during a procedure, the operating physician can operate both the endoscope and the steerable fiber with a single hand. We report simulation and phantom experiments demonstrating that the proposed device substantially enhances surgical access compared to current clinical fibers.

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“…Office-based laryngeal laser procedures continue to gain popularity as a safe, feasible, effective, and accessible treatment for benign and premalignant lesions of the larynx. [1][2][3][4] Due to its breadth of possible applications for a range of laryngeal pathologies, favorable outcomes, 1,2 and convenience for both clinicians and patients 5 with reduced cost and need for support from ancillary personnel and hospital resources, 6 laser removal of glottic lesions under local anesthesia offers a valuable alternative to traditional surgical resection in the operating room. 3 Due to technological advances in laser systems, optics and high-definition cameras over the past few decades, 7 the range of in-office laryngeal procedures has increased, with undeniable benefits.…”

Section: Introductionmentioning

confidence: 99%

Benefits of Side‐Firing Optical Fibers in Endoscopic Laser Treatment of the Larynx

et al. 2022

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Objective: To elucidate potential tissue coverage of side-firing optical fibers in office-based endoscopic laser treatment of larynx, as well as to demonstrate their enhanced ability to address challenging anatomic areas.Method: We performed a comparative study of four different fiber designs: a traditional forward-facing fiber, and three side-firing fibers that emit light at an angle of 45 , 70 , and 90 , respectively. The study was conducted in simulation, using eight three-dimensional models of the human larynx generated from microtomography x-ray scans. A computer program simulated the insertion of the endoscope into the larynx, and the Möller-Trumbore algorithm was used to simulate the application of laser light.Results: Side-firing laser fibers increased potential tissue coverage by a mean of 50.2 (standard deviation [SD] 25.8), 73.8 (SD 41.3), and 84.0 (SD 47.6) percent for angles of 45 , 70 , and 90 , respectively, compared to forward-facing fibers. Angled fibers provided access to areas of the larynx considered difficult to address by traditional methods, including the infraglottis, laryngeal ventricle, and right vocal fold.Conclusion: Simulation results suggest that side-firing optical fibers have the potential to enhance anatomical access during in-office endoscopic laser procedures in the larynx. Further research is needed to better understand the benefits and any potential risks or contraindications of side-firing optical fibers.

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Office Laser Laryngology: A Paradigm Shift

Cited by 10 publications

References 16 publications

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Benefits of Side‐Firing Optical Fibers in Endoscopic Laser Treatment of the Larynx

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