Carbon Dioxide Laser Microsurgery Research Articles

Carbon Dioxide Laser Microsurgery versus Low-Temperature Plasma Radiofrequency Ablation for T1a Glottic Cancer: A Single-Blind Randomized Clinical Trial.

Background Very few studies have been conducted to compare carbon dioxide laser microsurgery (CO2-LS) with low-temperature plasma radiofrequency ablation (LTP-RFA) in treating T1a glottic cancer. Therefore, we conducted this study to compare the efficacy of CO2-LS and LTP-RFA to define a superior therapeutic modality for T1a glottic cancer. Methods Patients (n=131) with T1a glottic cancer were recruited between January 2010 and September 2014. The included patients were randomly assigned to either receive CO2-LS (n=65) or LTP-RFA (n=66). We conducted the following multidimensional vocal assessments: (i) videostroboscopic evaluation; (ii) auditory-perceptual evaluation; (iii) aerodynamics/ efficiency; (iv) acoustics; and (v) self-assessment questionnaires. Meanwhile, the surgery time and three-year overall survival rates in two groups were recorded. The predefined primary endpoint was overall survival, and the minimum follow-up time was set to six months. Results After treatment, we found that the structure and vibration of vocal cord might recover more quickly in patients receiving LTP-RFA than in patients receiving CO2-LS, and moreover, the patients in the LTP-RFA group had the better vocal functions. Meanwhile, the surgery time was significantly less in the LTP-RFA group (8.83±1.59 minutes) than in the CO2-LS group (12.49±1.40 minutes) (p<0.00001). In addition, the two intervention methods had the similar three-year overall survival rates (94% versus 96%, p=0.58). Conclusion These results indicated that both LTP-RFA and CO2-LS could effectively treat T1a glottic cancer, and LTP-RFA might have some advantages in voice function. Limited by the relatively small sample size, future studies were needed to validate our conclusion.

Minimally Invasive Procedures for Laryngeal Carcinoma: Transoral Endoscopic Laser and Transoral Robotic Surgery.

Open partial or total laryngectomies with or without radiotherapy (RT) or chemoradiotherapy (CRT) are the only mainstays in the treatment of laryngeal carcinomas. However, minimally invasive procedures such as transoral endoscopic carbondioxide laser microsurgery (TLM) or transoral robotic surgeries (TRS) are now being increasingly used in selected patients. The laryngeal framework is not disturbed in these procedures; therefore, the postoperative swallowing function improves more rapidly, and routine tracheotomy is not usually required. Moreover, they have oncological results comparable with open procedures.

Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.

Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure

The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break "alley" between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings. All 20 patients had anterior glottic webs ranging from 11% to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months).All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients. One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.

Quelles nouveautes en 2008 dans le cancer du testicule et du pénis en recherche clinique et en recherche fondamentale ?

Few communications were devoted this year to the cancers of the male external genital organs. In stade I testis seminomas, data comparing 1 course of chemotherapy by carboplatin (AUC: 7) to retroperitoneal radiotherapy in adjuvant treatment were updated. Localizations of recurrences were different, depending on adjuvant treatment. In stage I non seminomatous testis cancer, active surveillance could be possible if there were not any vascular embols. Chemotherapy by 1 course of BEP was superior to retroperitoneal lymph node dissection in stage I. In Leydig cell tumors, conservative surgery was possible. In penile cancer management, dynamic sentinel node biopsy could be interesting. Carbon-dioxide laser microsurgery only for initially invasive squamous cell carcinoma of the penis could be proposed.

Intractable Chronic Myringitis Treated With Carbon Dioxide Laser Microsurgery

Intractable Chronic Myringitis Treated With Carbon Dioxide Laser Microsurgery

Intractable Chronic Myringitis Treated With Carbon Dioxide Laser Microsurgery

To determine the effect of carbon dioxide laser microsurgery in the treatment of intractable chronic myringitis (CM). Retrospective 10-year case note review. Tertiary referral hospital. We reviewed retrospective case notes for 30 treated ears in 29 consecutive patients with CM (ie, loss of the tympanic membrane for longer than 1 month, refractory to conservative medical treatment) who underwent carbon dioxide laser microsurgery between 1995 and 2004, excluding patients who had undergone previous otologic surgery such as tympanoplasty. Carbon dioxide laser microsurgery for resurfacing the nonepithelialized tympanic membrane was performed using local anesthesia. Resolution of disease in the affected tympanic membrane. Of 30 affected ears, 22 demonstrated total resolution of CM, 7 demonstrated partial resolution, and the status of 1 ear remained unchanged at the end of follow-up (mean,19.7 months). Revision laser therapy was performed in 3 ears, resulting in total resolution of disease in 1 ear. Time to total resolution of disease ranged from 1 to 16 months (mean, 2.95 months). We used carbon dioxide laser microsurgery to treat intractable primary CM and describe its efficacy in a retrospective review of laser resurfacing covering 10 years. We believe that laser microsurgery has the advantages of less invasiveness and higher applicability compared with aggressive surgical treatment. In patients with CM refractory to conservative medical treatment, carbon dioxide laser microsurgery could be an effective alternative when aggressive surgical procedures are not under consideration.

P134 Combined Transoral Laser Microsurgery and Intensity-Modulated Postoperative Radiation Therapy for Head and Neck Cancer

Objective: To evaluate the locoregional control and functional results of transoral carbon dioxide (CO2) laser microsurgery (TLM) followed with intensity-modulated radiation therapy (IMRT) for treatment of locally advanced head and neck carcinoma.

Carbon dioxide laser microsurgery for early glottic carcinoma

To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. A retrospective study of 103 patients with glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2) treated from October 1993 to June 2001. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. According to the Kaplan-Meier method, the probability of remaining free of local recurrence 5 years after primary surgery alone was 100% for the Tis, 96.05% for the T1, and 100% for the T2. Local control at 5 years after exclusive CO2 laser salvage surgery was 98.03%. The probability of remaining free of local recurrence 5 years after any type of salvage surgery was 100%. Laryngeal preservation was achieved in 100% of the cases. According to the present series, endoscopic CO2 laser surgery is an effective treatment for early glottic cancer. C-4.

Transoral carbon dioxide laser microsurgery for recurrent glottic carcinoma after radiotherapy.

Transoral laser microsurgery is successfully performed in the treatment of primary laryngeal carcinomas. Few publications deal with the application in patients with recurrent glottic carcinomas after radiation failure. Our study aims to review our experience with transoral laser microsurgery in these patients. Thirty-four patients with early and advanced recurrent glottic carcinoma after full-course radiotherapy (rT1, n = 11; rT2, n = 10; rT3, n = 10; rT4, n = 3) had CO(2) laser treatment with curative intent between 1987 and 1998. Twenty-four patients (71%) were cured with one or more laser procedures. In nine patients, recurrences could not be controlled by laser microsurgery: six patients underwent total laryngectomy and three palliative treatment. One patient received total laryngectomy because of chondronecrosis after laser treatment. With a median follow-up interval of 38.6 months, the 3-year and 5-year disease-specific survival was 86%. The overall 3-year survival rate was 74%; the corresponding 5-year survival rate was 53%. No major complications occurred. In three cases, temporary tracheostomy was needed. In early-stage and advanced-stage recurrent glottic carcinomas after radiotherapy, CO(2) laser treatment can successfully be used as a curative organ-preserving procedure. Compared with salvage laryngectomy, results are superior with respect to preservation of laryngeal function. Great expertise is required, especially in resections of advanced-stage recurrent carcinomas.

Carbon Dioxide Laser Microsurgery for Tongue Cancer: Surgical Techniques and Long-Term Results

Thirty-seven consecutive patients with cancer of the anterior two-thirds of the tongue without clinical neck lymph nodes or distant metastasis were treated with transoral carbon dioxide (CO2) laser microsurgery. During the operation, a monopolar coagulation-suction device was applied to achieve a clear surgical field. Under a surgical microscope, we repeatedly palpated the soft tissue to identify the tumour margins, in particular the deep margin, to maintain adequate safe margins in three dimensions. We resected the tumour by en bloc procedures rather than by vaporization or debulking. Of the 28 patients in the T1 and T2 groups, 26 patients did not receive postoperative radiotherapy. The local control rate calculated by the methods of Kaplan and Meier in all 37 patients at 5 years was 93.6%. No local recurrence occurred in the T1 or T2 cases. Nine patients suffered from neck recurrence and the neck control rate at 5 years was 74.6%. Eight of these nine patients were salvaged by surgery with adjuvant radiotherapy, and six of them finally achieved disease-free status. The 5-year disease-free survival rate for our series was 88%. Our surgical techniques using CO2 laser microsurgery are effective and advantageous methods for excision of oral tongue cancer, especially stage I and II lesions.

Carbon dioxide laser microsurgery of benign vocal fold lesions: indications, techniques, and results in 251 patients.

Two hundred fifty-one carbon dioxide laser-assisted cases of microphonosurgery are reported. Our series includes 167 women (66.5%) and 84 men (33.5%), with a mean age of 41 (+/-11) years. Single lesions represent 67.8% (n = 170) of the cases, with 20% (n = 50) being nodules, 18% (n = 44) Reinke's edema, 9% (n = 23) polyps, 8% (n = 19) sulci and related lesions, 6% (n = 16) mucosal cysts, 4% (n = 10) scars, 2% (n = 4) granulomas, and 2% (n = 4) vascular corditis. The cases with 2 or 3 lesions represented 32% (n = 81). Carbon dioxide laser-assisted microphonosurgery is efficient, provided the working parameters are strictly adhered to: micromanipulator micropoint providing a 250-microm laser beam for a 400-mm working distance; 0.1-second single pulses; and maximum power of 3 W with the superpulse wave. Glutaraldehyde-cross-linked collagen remains our filling material of choice in cases of vocal fold atrophy. Fibrin glue is useful for covering the resection area and for setting the microflaps. Microphonosurgery cannot be dissociated from speech therapy, the planning and duration of which, in relation to the procedure, depend on the nature of the initial lesion. Twenty to 30 sessions are usually adequate, but 6 months may be necessary in the case of sulcus vergetures. Our operating technique is derived from the microphonosurgery procedures with cold instruments. In addition to the classic advantage with regard to hemostasis, the carbon dioxide laser micropoint seems to make the dissection of microflaps easier.

Transoral laser surgery of supraglottic cancer: follow-up of 141 patients.

To determine the role of transoral laser resection of supraglottic carcinomas. Retrospective unicenter study of the oncologic results of transoral carbon dioxide laser microsurgery for supraglottic carcinomas performed between February 1979 and December 1993. Median follow-up was 37 months. University hospital academic tertiary referral center. We reviewed the medical records of 141 patients (a consecutive sample of 131 men and 10 women; mean age, 60 years) with histologically proven supraglottic carcinomas undergoing transoral laser surgery, possibly in combination with neck dissection or radiotherapy. Stage distribution of patients was as follows: stage I, 23.4%; stage II, 25.5%; stage III, 16.3%; and stage IV, 34.8% (according to the Union Internationale Contre le Cancer staging system). Recurrence-free survival rates and local and regional recurrence rates. Five-year recurrence-free survival rates were as follows: the whole case load, 65.7%; stage I, 85.0%; stage II, 62.6%; stage III, 74.2%; and stage IV, 45.3%, according to the Union Internationale Contre le Cancer staging system. The local and regional recurrence rates were 16.3% and 9.9%, respectively. The oncologic results of transoral carbon dioxide laser surgery are satisfying if clean surgical margins (R0 resection) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resection) and transoral revision is not possible, transcervical procedures (partial or total laryngectomy) should be performed. The indication for transoral supraglottic laryngectomy in T3 lesions should be considered with restraint.

Carbon dioxide laser microsurgery for early supraglottic carcinoma.

Forty-eight untreated patients with early supraglottic carcinoma (12 patients stage I and 36 patients stage II) had primary carbon dioxide laser microsurgery between 1979 and 1994 with the intent of complete tumor removal with preservation of functionally important structures of the larynx. Ninety-six percent of the patients were treated exclusively by surgery; 4% had laser microsurgery and postoperative radiotherapy. With a median follow-up of 55 months, the 5-year local control rate with the first treatment was 100% for pT1 cases and 89% for pT2 cases. The ultimate local control rate with voice preservation, including patients successfully salvaged after a local recurrence, was 97% for pT2 carcinomas. Five (10%) patients died of tumor (TNM)-related deaths. The 3-year recurrence-free rate and 3-year overall survival rate (Kaplan-Meier) were 87% and 85%; the 5-year recurrence-free rate and 5-year overall survival rate were 83% and 76%, respectively. The results achieved with transoral laser microsurgery in early supraglottic carcinoma are comparable to those of open supraglottic laryngectomy with respect to local control and survival. The functional results are superior, since clinically relevant aspiration did not occur.

An Insufflation Device for Anesthesia during Subglottic Carbon Dioxide Laser Microsurgery in Children

The carbon dioxide laser has become a popular instrument among laryngologists for subglottic microsurgery (1,2). Historically, insufflation has been a preferred anesthetic technique for surgical procedures that demand an unobstructed larynx (3), and indeed, insufflation has proven to be a reliable and simple anesthetic technique for laryngeal microsurgery (4–8). Insufflation techniques, however, usually utilize a pharyngeal catheter as the insufflation device. Because the position of this catheter is at times hidden from view, it can unintentionally become obstructed or result in misdirecting of fresh gas flows away from the trachea. It seemed to us, however, that potential problems associated with the use of a pharyngeal catheter could be avoided if the Andrews anterior commissure retractor (Fig. 1), widely used by surgeons to view the subglottic area, were employed as an insufflation device during subglottic carbon dioxide laser microsurgery in children.

The Risk of Endotracheal Intubation for Carbon Dioxide Laser Microsurgery of the Larynx

The Risk of Endotracheal Intubation for Carbon Dioxide Laser Microsurgery of the Larynx

Anesthesia for carbon dioxide laser microsurgery of the larynx.

Jet ventilation via the Sanders injector during intravenous general anesthesia provides excellent operative conditions for CO2 laser microsurgery of the larynx. This technique, which includes complete muscle relaxation, is superior to traditional methods of anesthesia because the endotracheal tube is eliminated, thus improving the surgical field and reducing burn hazards owing to ignition of the tube. The laryngoscope has been modified to carry multiple ports into which a 14-gauge needle is inserted and the tip advanced just distal to the vocal cords. This needle is securely attached to the injector and pressure from the oxygen source is adjusted according to the patient's build and total compliance. Satisfactory arterial blood gases, superb operating conditions, safety, and rapid awakening make this the method of choice for most patients.

New trends in carbon dioxide laser microsurgery.

The carbon dioxide laser has been used for cutting and cauterizing tissue in a variety of surgical procedures by means of a dry-field air/tissue interface approach. Recently, a new wet-field CO2 laser technique has been developed and is being used successfully in humans to seal intraocular fibrovascular fronds and retinal tears at the time of vitrectomy, to close rubeotic vessels in the iris, and to excise fibrovascular fronds and epiretinal membranes in cases of severe diabetic retinopathy. Specialized wet-field CO2 laser photosurgical probes for use in gynecologic microsurgery have been developed and are being studied experimentally. Other potential applications include otolaryngologic microsurgery, neurosurgery, and gastrointestinal and urologic wet-field surgery.

Anesthesia for Carbon Dioxide Laser Microsurgery on the Larynx and Trachea

Anesthesia for Carbon Dioxide Laser Microsurgery on the Larynx and Trachea