Laser-assisted Surgery Research Articles

Effectiveness of femtosecond laser-assisted cataract surgery in patients over 50 years of age in a private ophthalmology clinic in the city of Rosario, year 2022

Introduction: Cataract surgery is the most effective treatment to restore vision in those patients whose vision is significantly affected by lens opacity. This procedure has proven to be safe and effective, which has led to a significant improvement in the quality of life of patients who undergo this surgical intervention.Objective: To determine the effectiveness of such femtosecond laser-assisted surgery in patients over 50 years of age seen at the private ophthalmology clinic in the year 2022.Materials and methods: Quantitative observational study, with a descriptive, cross-sectional and retrospective design, carried out in a private ophthalmology clinic, during the period between May and June 2023. The population consisted of patients over 50 years of age, regardless of sex. The sample was non-probabilistic by convenience. Data collection was carried out through the review of the patients' medical records, obtained from the clinic's database. The data collected were entered into an Excel spreadsheet for subsequent analysis with Jamovi statistical software. Qualitative variables were expressed using frequency tables and pie charts or bar graphs, as appropriate. The Student's t test was used to compare quantitative variables with symmetrical or Gaussian distribution. Histograms and box plots were used to represent the distribution of quantitative variables.Results: Twenty-six patients were evaluated, their mean age was 69 years. Fifty percent of the operated eyes presented visual acuity less than or equal to 0.4 before surgery, while after surgery 50% of the operated eyes showed visual acuity above 0.9. It was observed that post-surgery 84.6% of the operated eyes increased visual acuity by up to 6 tenths and 15.4% increased visual acuity by at least 7 tenths. Twenty-five percent of the operated eyes decreased the number of endothelial cells post surgery by up to 2.33%, while there were 10% of operated eyes that showed no reduction of endothelial cells post surgery. No complications were identified in any of the femtosecond laser-assisted surgeries performed.Conclusions: It could be inferred that this femtosecond laser-assisted cataract surgery is effective, reproducible and safe

Nd-YAG laser-assisted pulmonary metastasectomy: initial experience from a tertiary care cancer center in India.

Pulmonary metastasectomy is recommended for metastatic lung lesions when R0 resection is possible, the primary site is in controlled status, surgery is of low risk, and extrathoracic metastases are absent. We present the initial experiences of laser-assisted surgery (LAS) for pulmonary metastatic lesions from a tertiary care cancer center in India. All patients undergoing non-anatomical pulmonary metastasectomy between September 2022 and January 2023 for synchronous and metachronous lesions, operated on by a single consultant thoracic oncosurgeon in a tertiary care center of India, were identified from a prospective database. Ten patients with 124 metastatic lesions were included in the study. A hybrid approach (video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy) was performed. Measurements of total lesion volume and lung parenchyma resected were taken from the final histopathological analysis of the intraoperative sample. LAS was performed for 102 lesions and stapled wedge resection for 22 lesions. Evidence of malignancy was noted in 88/102 (86.3%) of the lesions excised. Patients with LAS had advantages of parenchyma preservation, less postoperative morbidities, and shorter hospital stays. LAS of pulmonary metastatic lesions addresses more lesions in a single sitting; the bilateral lung lesions can be operated and has parenchyma preserving and good sealant properties. The online version contains supplementary material available at 10.1007/s12055-024-01723-8.

High-output ∼3 μ m MIR pulsed laser enabled by surface state regulation in PtTe2 optical switch

Mid-infrared (MIR) pulsed lasers operating in the ∼3 μm region play a crucial role in various applications, including molecular spectroscopy, ultrafast molecular imaging, and laser-assisted surgery. Despite recent advancements in MIR gain platforms, a notable technological challenge remains in the absence of an effective optical Q-switch. Here, a remarkable optical Q-switch in the 3 μm region based on a Dirac semimetal PtTe2 saturable absorber is realized. By modulating the surface state of PtTe2, the pulsed laser exhibited an increase in average power, escalating from 521 to 588 mW, accompanied by a significant decrease in pulse width from 368 to 187 ns. Nondegenerate pump–probe measurements showed that the recombination rate of the photocarrier in thinner PtTe2 nanoplates was effectively accelerated, primarily attributed to the substantial increase in surface state density, leading to better saturable absorption performance. As the thickness of the PtTe2 nanoplates decreases, the nonsaturable loss decreases from 12% to 3%, while the modulation depth increases from 6% to 12%. The enhanced ultrafast nonlinear absorption enables flexible modulation of saturation absorption parameters, which endows high-performance MIR pulsed laser generation.

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

To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions. This 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. Sixty-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). Awake 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. 2 Laryngoscope, 134:3732-3740, 2024.

Management of Ankyloglossia in a Non-Syndromic Patient Using a Super Pulsed Laser: A Life-Changing Treatment- A Case Report

Objective: Ankyloglossia affects a person’s overall well-being and life, from malnutrition due to poor feeding and mechanical problems to psychological stress and low self-esteem, thus affecting social life. This case reports the use of non-scalpel techniques, such as a super pulsed laser, to manage ankyloglossia in a non-syndromic patient suffering from speech incompetence and restricted tongue mobility and highlights its advantages over other conventional techniques. Case Report: A 17-year-old male patient presented with a complaint of restricted tongue mobility, due to which he could not pronounce certain words clearly. As the patient was apprehensive about the use of a scalpel, it was decided to manage ankyloglossia using a diode laser against the conventional scalpel technique. Thus, the laser-assisted lingual frenectomy using GaAs super pulsed laser was used to excise the lingual frenulum. Conclusion: This case report suggests that ankyloglossia can be successfully treated by using laser-assisted surgery and gives superior results specifically in terms of lesser pain and bleeding

Femtofakoemulsyfikacja zaćmy – 10 lat doświadczeń

Femtosecond laser-assisted cataract surgery is a procedure known for more than a decade. The review compares this surgical technique with conventional cataract phacoemulsification – the most frequently performed operation of this type. The review took into account metanalysis, clinical trials and reports from the last 10 years to evaluate several aspects, including intraoperative parameters, surgical complications and advantages for patients. Femtosecond laser-assisted cataract surgery is the method with less effective phacoemulsification time, cumulative dissipate energy and better intraocular lens centration. Reduction of aberrations in presbyopia correcting intraocular lens is also noticeable. Best uncorrected and corrected visual acuity and postoperative predicted refraction are similar in both groups of patients. Surgical complications are comparable as well. Noteworthy is the fact that patients with hard nuclear cataracts have smaller endothelial cell loss. The results for low and medium severity of cataracts are mostly the same in laser-assisted surgery versus phacoemulsification. Femtosecond laser-assisted cataract surgery is a new solution for patients with low endothelial density or endothelial dystrophy, especially in advanced cataracts. The procedure is also recommended for surgery with presbyopia-correcting lens implantation due to better centration and smaller ocular aberrations. This whole new surgical technique requires greater financial outlay but provides some improvements in cataract surgery

Effective Treatment Modalities for Oral Mucocele in Young Pediatric Patients: Case Series and Literature Review

Oral mucocele is a common soft-tissue benign lesion in children that is generally reported in the literature with underlying etiology of traumatic event to the oral mucosa. Such lesions have been reported to be managed clinically by different therapeutic modalities ranging from conventional surgery to laser-assisted surgery. The appropriate treatment modalities for mucocele of oral mucosa in pediatric patients are utmost important for having favorable healing outcomes without any postoperative complications and recurrence. Hence, the selection of appropriate therapeutic options is very critical for achieving the desired results of treatment of such lesions. This article illustrates the clinical case series regarding the effective and successful management of extravasation mucoceles at different locations of oral mucosa in three pediatric patients including 5-month-old male infant, 7-year-old boy, and 8.5-year-old boy. The case report has been written as per the CARE case reporting guidelines.

Endoscopic stapedotomy: A comparison between the conventional approach versus CO2 laser-assisted surgery.

Although the utility of laser fiber in microscopic stapes surgery has been documented in the past, their role can be highly emphasized in endoscopic stapes surgery, especially in difficult anatomical situations. This is a retrospective analysis of cases where a total of 46 patients (22 in conventional stapedotomy and 24 in CO2 laser-assisted stapedotomy) were included in the study. The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy. A total of 90.90% (20/22) of the patients in the conventional stapedotomy and 95.83% (23/24) of patients in laser-assisted stapedotomy had <20 dB of AB gap in the postoperative period (P = 0.71). Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same (P = 0.01). Chorda tympani nerve was manipulated in 59.09% (13/22) and 25.00% (6/24) of cases in the conventional group and in the CO2 laser group, respectively (P = 0.01). Although the audiological outcomes with fiber-enabled CO2 laser in endoscopic stapedotomy are comparable to conventional surgery, it is a better tool in a narrow auditory canal, requiring minimal manipulation of the chorda tympani nerve.

The use of low level laser therapy in conjunction with diode laser-assisted and conventional vestibuloplasty: Comparison of wound healing and vestibular depth gain

BackgroundThe aim of this study is to compare wound healing and vestibular depth gain in individuals undergoing vestibule deepening surgery using diode laser and conventional technique and to further investigate the possible wound healing effect of low-level laser therapy (LLLT). Material and Methods52 systemically healthy individuals with insufficient vestibular depth in the region of teeth 33–43 in the lower jaw were included. Following nonsurgical periodontal treatment, patients were divided into four groups as follows: a) diode laser (L); b) diode laser + LLLT; c) conventional surgery and d) conventional surgery + LLLT. Vestibular depth and horizontal wound size measurements of the individuals were recorded using digital calipers. Reepithelization was evaluated via an image analysis program. ResultsVestibular depth measurements were found to be higher in the conventional surgery groups compared to that of diode laser groups after the operation, while the results were not statistically different between groups (p >0.05). Reepithelization area did not differ between groups in the evaluated time periods (p >0,05). On the other hand, horizontal wound shrinkage was significantly higher in the conventional surgery group than that of diode laser. ConclusionsWithin the limits of this study, both methods yielded in vestibule depth gain. On the other hand, LLLT did not have an additional positive effect on mucosal wound healing. As a clinical relevance, the results are valuable for clinicians in terms of showing that suturing of the mucosal flap formed following vestibule deepening should not be necessary in laser assisted surgery for attaining more vestibule depth.

Reasons for failure in surgical treatment of patients with rhonchopathy and obstructive sleep apnea syndrome

Purpose. To study specific approaches for selecting patients with rhonchopathy and obstructive sleep apnea syndrome for surgical treatment and to study laser surgical techniques applied on the soft palate so as to identify basic reasons of postoperative complications, soft palate function disorders and relapses of the disease with an even more aggressive course than before the surgery.Material and methods. In 2011–2020, 523 patients with rhonchopathy and obstructive sleep apnea syndrome, aged 23–78, were selected for surgical treatment. The authors discuss the obtained data after analyzing the effectiveness of used criteria for selecting patients for laser-assisted surgery on the soft palate, as well as after analyzing outcomes after laser sculptural uvulopalatoplasty performed in 309 patients. Reasons for insufficient effectiveness of surgery in some patients have been analyzed too.Results. After analyzing selection criteria, it has been found out that only 309 patients out of 523 (59.1 %) had no contraindications to laser sculptural uvulopalatoplasty, while 214 patients (40.9 %) had them. The discussed surgery was effective in 304 out of 309 operated patients (98.4 %) which has been confirmed with a complete and stable relief from night snoring and its complications for five or more years after the surgery. No effect was registered in 5 (1.6 %) patients because they absolutely ignored strict following the prescribed regimen, diet and other recommendations aimed to promote physiological healing of surgical wounds.Conclusion. The effectiveness of laser sculptural uvulopalatoplasty depends on a careful and adequate selection of patients for this surgery as well as on rational choice of laser light parameters; failures are due to inadequate selection of patients and their unwillingness to strictly follow recommendations in the postoperative period.

Laser pulmonary metastasectomy preserves parenchyma: a single-centre retrospective study from the United Kingdom

BackgroundPulmonary metastasectomy (PME) is a modality increasingly employed to control oligometastatic disease from a variety of solid tumours.We present data from a single UK centre, following the introduction of laser-assisted surgery (LAS) using the Limax® 120 Nd:Yag laser (Gebrüder Martin GmbH & Co. KG, Tuttlingen, Germany).MethodsAll patients undergoing PME between September 2015 and August 2018 were included in our study. Those undergoing LAS were compared to a control of conventional stapled wedge metastasectomy (SWM). Data was analysed retrospectively from a prospective kept database. Statistical analysis was performed using JASP (Version 0.14.1).ResultsFifty-seven procedures in 46 patients, were included in the final analysis. Demographic data was similar at baseline between the LAS and SWM group, with colorectal cancer being the most common primary, 44/57 (77%). LAS was favoured in patients who had previously undergone pulmonary metastasectomy, 9/12 (75%). Patients in the LAS group had a smaller parenchymal volume resected (MD 30.6 cm3, p = 0.0084), with a lower incidence of clear histological marginal resection (11/27 vs 29/30, p < 0.0001); but no difference in operative time, morbidity, patient-reported outcome measures, or local recurrence between the two groups at 2 years. LAS was associated with a lower procedural cost (MD £452.92, p < 0.0001).ConclusionsLaser-assisted pulmonary metastasectomy presents a safe and acceptable alternative to traditional stapled wedge resection, with notable parenchymal-sparing, no discernible learning curve, and lower direct costs.

Метод лечения рецидивирующего герпетического кератита на основе послойной кератопластики с фемтосекундным сопровождением (серия клинических случаев)

Purpose. To evaluate the clinical efficacy of lamellar keratoplasty in the treatment of recurrent herpetic keratitis with femtosecond laser-assisted corneal surgery. Material and methods. In two clinical cases, lamellar keratoplasty with femtosecond laser-assisted corneal surgery was performed. Preoperative and postoperative visual acuity, refractometry, keratotopography, pachymetry were examined. Conducted courses of conservative treatment: antiviral, anti-inflammatory, desensitization therapy using vaccination «Vitogerpavak». Results. Evidence of the effectiveness of the proposed method was obtained - stabilization and relief of the inflammatory process, increased visual acuity and cosmetic effect. Conclusion. Cases of successful treatment of recurrent herpetic keratitis after intensive courses of conservative treatment followed by lamellar keratoplasty with femtosecond laser-assisted surgery are presented. The use of femtolaser technologies, which allow dosed excision of the affected tissue at a certain depth according to predetermined parameters, contributes to the achievement of high functional results. Lamellar keratoplasty with the maximum possible excision of scar tissue and its replacement with a donor cornea is a minimally invasive effective method to restore the transparency of the cornea after therapeutic treatment of recurrent herpetic keratitis. Key words: keratoplasty, herpetic keratitis, femtosecond laser

Task Autonomy of a Flexible Endoscopic System for Laser-Assisted Surgery.

Laser beam steering has been widely studied for the automation of surgery. Currently, flexible instruments for laser surgery are operated entirely by surgeons, which keeps the automation of endoluminal surgery at the initial level. This paper introduces the design of a new workflow that enables the task autonomy of laser-assisted surgery in constrained environments such as the gastrointestinal (GI) tract with a flexible continuum robotic system. Unlike current, laser steering systems driven by piezoelectric require the use of high voltage and are risky. This paper describes a tendon-driven 2 mm diameter flexible manipulator integrated with an endoscope to steer the laser beam. By separating its motion from the total endoscopic system, the designed flexible manipulator can automatically manipulate the laser beam. After the surgical site is searched by the surgeon with a master/slave control, a population-based model-free control method is applied for the flexible manipulator to achieve accurate laser beam steering while overcoming the noise from the visual feedback and disturbances from environment during operation. Simulations and experiments are performed with the system and control methods to demonstrate the proposed framework in a simulated constrained environment.

Electron microscopy analysis of femtosecond laser-assisted capsulotomy before and after lens fragmentation

Studying anterior lens capsule cutting edge profiles from femtosecond laser-assisted capsulotomy procedures performed before and after lens fragmentation. Twenty eyes (10 patients) with age-related cataract underwent femtosecond laser-assisted surgery (FLACS) using the Ziemer Z8 platform. First step of laser surgery was either capsulotomy (group first) or fragmentation (group second). One eye of each patient was assigned randomly, the second eye treated with the different sequence of procedures. After anterior capsule removal, tissue was fixed in cacodylate-buffered solution and cutting-edge profiles were analysed using scanning electron microscopy (SEM). All cases had cataract grade 2 and 3 based on LOCS III grading. SEM analysis showed more smooth edges in the first group, especially in cases with pseudoexfoliation (P = 0.037); more tags and bridges and a significant number of staggered cutting patterns (7 out of 10 cases) in the second group. All cases evolved the same microgroves with “valleys and mountains “ as signs of the photodisruption process. Femtosecond laser capsulotomy should be performed before lens fragmentation minimizing the rate of cutting errors. Especially in eyes with advanced cataract, as intracapsular pressure may increase due to lens fragmentation without anterior capsular opening.

Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis.

The aims of this meta-analysis were to evaluate the results of intracorneal ring segments (ICRSs) and MyoRing in the management of corneal ectasia and to compare the clinical outcomes and complication rates between mechanical and femtosecond (FS) laser-assisted surgery. An online electronic search was performed for pre-post studies published until April 2020. Uncorrected distance visual acuity, corrected distance visual acuity, sphere, cylinder, spherical equivalent, steep, flat, and mean keratometry values were considered as outcomes. Weighted mean difference with 95% confidence interval was used as a pooled estimation of intervention efficacy. Of 1484 potentially related studies, 115 studies were finally included in the meta-analysis. Findings of this meta-analysis demonstrated considerable improvement in visual, refractive, and keratometric outcomes in all ICRS models and MyoRing. Intrastromal tunnel creation with both methods yielded similar results. Complication rates were without exception higher when mechanical dissection was used. ICRS and MyoRing are appropriate treatment options for patients with corneal ectasia. Both techniques for tunnel creation are efficacious in achieving good visual, keratometric, and refractive results. Mechanical intrastromal tunnel creation is associated with much higher complication rates when compared with FS laser-assisted technique.

Posterior lamellar keratoplasty: techniques, outcomes, and recent advances.

Over the past 2 decades, posterior lamellar keratoplasty (PLK) has emerged as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. The reasons for this trend include the search for a safer procedure to replace diseased endothelium that provides faster and better visual rehabilitation and reduces the need for postoperative care. Different surgical techniques, surgical instruments, devices, and lasers have been introduced to overcome technical difficulties, thus improving clinical outcomes. Yet, surgeons and eye banks must address the complications and limitations that arise during the transition to these new techniques. This review discusses the most significant aspects of the evolution of PLK, including a detailed description of current techniques and the direction of future treatment for corneal endothelial disease with the use of laser-assisted surgery, bioengineered corneas, cell therapy, and new pharmacologic therapy.

Diode laser-assisted frenectomy - A case report

Frenectomy, the removal of buccal frenum, is a common procedure in oral surgery as high attachment of frenum may cause prosthodontic issues, periodontal disorders and orthodontic disorders. The use of surgical diode lasers associated to laser biostimulation can increase patients’ compliance to this procedure. A 48-years old male patient presented with a low attachment buccal frenum and prosthetic issues. A decision was made for laser-assisted surgery with diode laser 810nm (Elexxion Nano, Elexxion). The excision procedure used continuous mode, power 2.5W, optic fibre with diameter 400μm. The surgical procedure was ended with low-level laser procedure using biostimulation module of the diode laser. VAS indices decreased from 3,8 immediate post-operatively to 2,6 (1 day post-operatively), and 0,4 (3 days post-treatment). The wound healing was completed at 12 days post-treatment. Diode laser-assisted frenectomy had many postoperative advantages as follows: absence of bleeding and oedema, low pain intensity at 1 day and 3 days, the absence of postoperative pain at 7 days, reduced wound healing time. The clinical application of the diode laser in frenectomy was easy-to-use, efficient, safe, and can be considered a valid alternative surgical procedure in relation to the classic surgical procedure.

Comparative perceptual evaluation and acoustic voice analysis of a transgender client male to female before and after laser-assisted voice adjustment surgery

In this study, we examined changes in the voice quality of a transgender client who had previously undergone male-to-female (MtF) transition. We conducted a longitudinal phonetic analysis after obtaining recordings from our client before and after undergoing laser-assisted voice adjustment (LAVA) surgery. The following acoustic parameters were compared: fundamental frequency (F0) measures, local jitter, shimmer, harmonic to noise ratio, phonation time, and long-term average spectrum. We assumed that the voice would not change significantly as a result of previous hormonal and vocal therapy, and that its timbre would be closer to female values after LAVA surgery. Since the client was on hormone therapy before the surgery, the average values of F0 corresponded to the values of a normal female voice (190.1 Hz), and, after surgery, the voice became significantly higher in phonation (235.6 Hz). Before surgery, the voice was high for a male voice during reading (mean F0 = 150.19 Hz for non-fricative text (NT) and mean F0 = 158.06 Hz for fricative text (FT)). After surgery, the voice exhibited higher F0 values (F0 = 184.72 Hz for NT and F0 = 191.87 Hz for FT). Before surgery, the voice was average high for a male voice during spontaneous speech (F0 = 119.90 Hz), while after surgery the F0 was 161.33 Hz during spontaneous speech, which is somewhat lower than the average pitch values of the female voice, but its timbral quality is more feminine. Since spontaneous speech is very important for comparison vocal timbre, we can conclude that the 42 Hz difference observed is notable. Although the minimal and maximal values of F0 based on phonation were significantly higher after surgery (p &lt; 0.001), the range was limited. The total results of the F0 measures are higher than expected, while the shortened phonation time points to the need for voice therapy. Considering all our results, we can conclude that it is important to discuss a client’s profession before considering LAVA surgery.

Surgical Morbidity and Lung Function Changes After Laser-Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study.

Objective: The surgical resection of pulmonary metastases is associated with a survival benefit in selected patients. The use of laser devices for pulmonary metastasectomy (PM) is believed to facilitate the complete resection of metastases while preserving a maximum of healthy parenchyma. This is a prospective study to evaluate surgical outcome including the changes of lung function after laser–assisted surgery (LAS).Methods: A total of 77 operations in 61 patients in which PM was carried out in a curative intent were analyzed. A 1.320 nm diode-pumped Nd: YAG-Laser was used for resection of the metastases. Surgical and clinical data were collected using a standardized form and postoperative lung function changes 3 and 6 months after surgery were assessed using whole body plethysmography and diffusion capacity for carbon monoxide (DLCO). Size and distance of metastases to the pleural surface were measured radiologically.Results: A median of two metastases were resected per operation (range 1–13). The median duration of postoperative air leak was 1 day (range 0–11). LAS associated postoperative minor and major complications were observed in 4 (5%) cases and 1 (1%) case, respectively; there were no mortalities. The analysis of perioperative lung function showed that mean VC 3 months after surgery was reduced by 11 %, FEV1 by 11% and median DLCO by 11% (all p < 0.0001). There was almost no recovery of lung function between 3 and 6 months in the whole cohort. Patients with two or less metastases showed a recovery of lung function after 3 months regarding DLCO (p = 0.003). Decline of DLCO in the whole cohort correlated with the number of resected metastases at 3 months (r = 0.45, p = 0.006) and at 6 months (r = 0.42, p = 0.02) as well as depth of metastases in the parenchyma at 6 months (r = 0.48, p = 0.001).Conclusions: LAS is a safe and effective method for PM even for higher numbers of metastases, with short duration of postoperative air leak and little morbidity. Number and depth, but not size of metastases affect lung function changes after resection.

Office-based procedures in laryngology.

SUMMARYObjectiveDevelopment of transnasal fiberoptic laryngoscopy, integration of an operative channel (OC), the advent of high-definition television imaging, with improvements in laser technology, cleared the way for office-based laryngology. Three treatment categories can be identified: bioendoscopy-guided biopsy; laryngeal injection; laser-assisted surgery.Methods26 patients underwent OBPs at the Otolaryngology Clinic of IRCCS Policlinico San Martino, Genoa, Italy. Sixty-eight procedures were performed: 60 for recurrent respiratory papillomatosis (RRP), 5 for unilateral vocal fold paralysis (UVFP) and 3 for glottic leukoplakias. Neoblucaine 5% was administrated through the operative channel, for local anaesthesia. All procedures were carried out with the physician standing behind the patient. Narrow band imaging (NBI – Olympus Medical) or i-scan (Pentax Medical) were used to enhance the accuracy of the biopsy thanks to identification of atypical vascular patterns. Laryngeal injections were made using a 25G flexible needle. Opera Evo (Quanta system IEC/EN 60825-1:2007) is a hybrid fibre laser that is used for “blanching” and vaporisation of RRP lesions and to treat selected leukoplakias that were previously biopsied.ConclusionsNo major complications occurred during the procedures.