Instructional Session: ISW9

Wednesday 4 July 2018, 16.45-17.45

Office-based laser surgery

Markus Hess, Deutsche Stimmklinik

Office-based procedures with topical anesthesia avoid the risks that come with general anesthesia, and they also avoid the disadvantages that may occur with placement of the laryngoscope in suspension microlaryngoscopy. Furthermore, office-based intervention is mostly offered in an ambulatory setting and thus can help saving costs. In general, office-based surgery has the advantage of having (i) realistic physiological muscular tension of the vocal folds, (ii) physiological endolaryngeal configuration and (iii) the possibility to immediately assess the voice as a result of intervention and using videostroboscopy. Laser surgery is performed with 300 to 400 micron glass fibres routed through channeled endoscopes. Indications are laryngeal papilloma, polyps, Reinke’s edema, granuloma, capillary ectasias and dysplasia. Masses can be treated because of laser effects based on coagulation, carbonisation, evaporisation, and photoangiolytic properties. Many other instruments were designed to treat laryngeal problems: cupped forceps, alligators, scissors, needles etc., in various sizes and shapes, for transoral and transnasal approaches. Procedures can be done by one surgeon, however, some interventions require a third hand (physician or nurse). Within the presentation, several topics will be covered, especially the clinical setting, anesthesia, medication, laser use, glass fibre handling, safety measures, tipps and tricks. Many cases will be shown with instructive video clips. Special information will be given about kalium titanyl potassium (KTP) and ‘blue’ laser interventions.