Randomized Controlled Trial of Awake Transnasal Laser‐Assisted Surgery for Benign Laryngeal Lesions

Abstract

ObjectiveTo compare functional and cost‐effectiveness of awake transnasal laser assisted‐surgery versus microlaryngeal surgery for benign laryngeal lesions.MethodsThis was a prospective non‐inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block‐randomized to receive either awake transnasal laser‐assisted surgery or microlaryngeal surgery, with post‐operative follow‐up in a multidisciplinary voice clinic for 1‐year. Primary outcome was Voice Handicap Index (VHI‐30). Secondary outcomes included operation time, complications, length of stay, peri‐operative discomfort, recurrence, and medical costs.ResultsSixty‐one patients were randomized to either awake transnasal laser‐assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI‐30 score over time and had comparable post‐operative VHI‐30. Awake transnasal laser‐assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost‐analysis showed a significantly lower hospital cost for awake transnasal laser‐assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120).ConclusionAwake transnasal laser‐assisted surgery was safe, functionally non‐inferior, as measured by VHI‐30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri‐operative discomfort and medical costs.Level of EvidenceLevel 2 Laryngoscope, 2024