In a retrospective study, we analyzed 97 patients who were treated by either transcutaneous diverticulectomy (n = 66) or microendoscopic myotomy of the cricopharyngeal muscle with CO(2) laser (n = 31). Two (6.4%) of 31 patients in the microendoscopic myotomy group had complications, compared with 10 (15%) of 66 patients in the diverticulectomy group. In addition, the complications observed in the microendoscopic myotomy group were less severe than those observed in the transcutaneous diverticulectomy group. The average length of hospitalization was shorter in the microendoscopic myotomy group than in the diverticulectomy group (8 days versus 11.4 days). We conclude that microendoscopic CO(2)-laser myotomy is a less invasive, more precise, and safer procedure, which results in a shortened period of hospitalization and complete relief of symptoms in the vast majority of cases.

Among different types of lasers, the erbium laser exhibits particularly favourable characteristics for ear surgery. Experiments with application of erbium laser pulses to the isolated stapes connected to an inner ear model confirmed that there was virtually no thermal effect to the inner ear liquid and that the border damage zone on the stapes footplate perforation did not exceed 5-10 microm. Erbium laser pulses, however, produce pressure waves due to the explosive ablation of tissue. Pulses of 10 to 17 J/cm2 producing pressure waves between 140 and 160 dB appear to be a limit for clinical application. With these criteria, an in-house built erbium YAG laser with a fiberoptic delivery device was used in 15 patients for stapedotomy. A special microhandpiece, where a zirconium fluoride fiber was connected to a quartz tip, was developed. In addition, three patients had stapedotomy with a commercially available Zeiss (Opmi TwinER) microscope equipped with a micromanipulator-operated erbium laser beam. One year after surgery, the air-bone gap was closed in all patients to within 20 dB between 0.5 and 3 kHz with only minor permanent bone conduction threshold losses (< 20 dB). However, we observed an immediate postoperative middle and high frequency loss of up to 75 dB on bone conduction threshold measurements 2 h after surgery, suggesting an acoustic traumatization by the erbium laser. This threshold shift recovered close to preoperative values within 6 h. These observations prompted us to discontinue the clinical use of erbium laser for stapedotomy until the problem of temporary acoustic traumatization is resolved.

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Fragestellung: Ziel dieser Untersuchung war es, die Resultate, die Komplikationen sowie die Vorteile der mikroendoskopischen Schwellendurchtrennung mit dem CO₂-Laser beim Zenker-Divertikel zu analysieren und mit Angaben aus der Literatur zu vergleichen. Patienten und Methode: Es handelt sich um eine retrospektive Analyse von 63 Patienten mit Zenker-Divertikel, bei welchen eine mikroendoskopische Durchtrennunng des Musculus cricopharyngeus mit dem CO₂-Laser durchgeführt wurde. Ergebnisse: 2 der 63 Patienten hatten Komplikationen (postoperative Blutung und makroskopisch sichtbare Eröffnung des Mediastinums). Die durchschnittliche Hospitalisationsdauer war 6,9 Tage. 58 der 63 Patienten waren mit dem Resultat zufrieden, 4 Patienten waren ziemlich zufrieden und 1 Patient erklärte sich unzufrieden. Schlussfolgerungen: Die mikroendoskopische Durchtrennung des M. cricopharyngeus mit dem CO₂-Laser beim Zenker-Divertikel ist eine wenig invasive, präzise und sichere Behandlungsmethode. Die meisten Patienten sind mit den Resultaten sehr zufrieden; die Hospitalisationsdauer ist kürzer als bei der klassischen transzervikalen Behandlungsmethode.