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Abstract
Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.
Highlights
Laryngeal squamous cell carcinoma (LSCC) is a common malignancy, representing 30%–50%of all neoplasms in the head and neck, with 157,000 new cases diagnosed worldwide in 2012 [1].The management of early stage (Tis, T1, T2) laryngeal cancer (Supraglottic, Glottic, and Subglottic) has evolved over the last 40 years from the classic open surgical resection techniques to a less aggressive and more functional endoscopic approach due to the evolution of surgical strategies, diagnostic workup, and follow-up protocols
The main advantage of transoral laser microsurgery remains in the possibility of minimizing the area of the larynx, which is resected during the surgery, preserving more healthy tissue and optimizing the patient’s recovery, airway management, as well as post-surgical voice without compromising their overall survival [3]
Due to its wavelength (10,600 nm), the CO2 Laser is absorbed by water, allowing very predictable cutting and an ablation mode with an optical penetration that is limited to tissues
Summary
Laryngeal squamous cell carcinoma (LSCC) is a common malignancy, representing 30%–50%. The management of early stage (Tis, T1, T2) laryngeal cancer (Supraglottic, Glottic, and Subglottic) has evolved over the last 40 years from the classic open surgical resection techniques to a less aggressive and more functional endoscopic approach due to the evolution of surgical strategies, diagnostic workup, and follow-up protocols. CO2 Laser Surgery of the Larynx has gained followers around the world during these four decades, becoming the gold standard for almost all early stage cancer (Tis–T2). This is the reason why in this review, the authors try to summarize and expose the most relevant concepts about the technique
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