CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review

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.

Systematic review and meta‐analysis of transoral laser microsurgery in hypopharyngeal carcinoma

“…This population is limited to patients with good oral access and cervical spine mobility. As well, surgeon experience is a critical feature in determining the success of surgery . Patients with advanced T stage with cartilage involvement or transglottic spread would be excluded.…”

“…As well, surgeon experience is a critical feature in determining the success of surgery. 37 Patients with advanced T stage with cartilage involvement or transglottic spread would be excluded. Certain authors showed a selection bias for patients with early T-stage disease.…”

Lasers in Οtolaryngology: A Laser Odyssey From Carbon Dioxide to True Blue

“…1,2 Transoral CO 2 laser microsurgery under anesthesia or in the setting of office laryngology in awake patients has been used for both benign and oncological laryngeal work. 5 Early laryngeal carcinoma can be successfully treated both with laser surgery and radiotherapy, yet the latter may have some undesirable long-term side effects, whereas laser cordectomy offers quick recovery and the possibility of second look when healthy margins are in doubt. Better and more accurate staging systems for endoscopic laser cordectomies have meant better understanding and communication between surgeons and pathologists.…”

“…4,5 Different types of lasers offer different tissue manipulation and in some cases have a superior outcome in comparison to the standard CO 2 laser. 5 Diode laser, KTP, and PDL cause better photocoagulation and, by extension, better hemostasis. 2,6,7 Other technical characteristics, such as flexibility and portability, make these lasers preferable and more cost-effective in some cases of laryngeal surgery.…”

“…2,6,7 Other technical characteristics, such as flexibility and portability, make these lasers preferable and more cost-effective in some cases of laryngeal surgery. 5 KTP and PDL are no longer manufactured and more recently a new laser, the so-called true blue, has emerged in laryngeal practice, combining photoangiolytic and cutting properties. This new 445-nm wavelength laser, the so-called ''blue laser,'' proves to show tissue effects comparable to the KTP laser and is also capable of treating subepithelial vessels, it can coagulate and carbonize at higher energy levels, and can be used via glass fibers in noncontact and contact mode for inoffice procedures.…”