In‐Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative

Anderson, Jennifer; Bensoussan, Yael; Townsley, Richard; Kell, Erika

doi:10.1177/0194599818774511

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…24 Office TNFLS is well tolerated, 25,26 with low complication rates of 4% to 8% reported, a majority of which are minor and self-limiting. 12,27 At present, photoangiolytic lasers such as KTP and PDL predominate in office-based TNFLS. The selective absorption of these wavelengths by oxyhemoglobin allows for angiolysis of superficial and subepithelial vessels with minimal absorption by surrounding superficial tissues and low bleeding risk.…”

Section: Discussionmentioning

confidence: 99%

“…24 Office TNFLS is well tolerated, 25,26 with low complication rates of 4% to 8% reported, a majority of which are minor and self-limiting. 12,27…”

Section: Discussionmentioning

confidence: 99%

“…In one of the largest TNFLS case series, the most commonly encountered complications were transient vasovagal episodes (4.1%) and early termination of the procedure due to patient tolerance (13.1%). 12 Comprehensive preoperative counseling on patient experience is essential to mitigate these risks and should include patient familiarization with the office environment and team, completion of informed consent, and provision of written and video literature on TNFLS, prior to the day of surgery.…”

Section: Patient Selectionmentioning

confidence: 99%

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Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

2020

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Background: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. Objectives: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. Methods: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. Results: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia ( P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. Conclusions: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.

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Section: Discussionmentioning

confidence: 99%

“…24 Office TNFLS is well tolerated, 25,26 with low complication rates of 4% to 8% reported, a majority of which are minor and self-limiting. 12,27…”

Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

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Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

2020

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“…A standardized laryngeal injection flow sheet was used to document the procedure including the pathology, site of injection, amount of local anesthetic and any complications (Additional file 1). This flow sheet was adapted from the In-Office laser flow sheet that has been used in our center [14]. A separate consent was also done as per usual treatment protocol.…”

Section: Description Of Vfsimentioning

confidence: 99%

The role of steroid injection for vocal folds lesions in professional voice users

Al-Ali

Anderson

2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: Benign vocal fold lesions identified in professional voice users, frequently require further treatment after failure of conservative measures. The role of vocal fold steroid injection as a treatment option for select benign lesions is the focus of this study. Steroid injection may avoid phonosurgery in some individuals thereby reducing the potential for adverse side effects associated with surgery. Objective: The purpose of the study is to review the effect of steroid injection on vocal function in professional voice users associated with a benign lesion(s) using the Voice Handicap Index-10. Method: This study is a retrospective review of patients (professional voice users) that underwent 1 or more steroid injection(s) between July 2014-December 2018. The Voice Handicap Index-10 was compared from pre to post treatment. Patients were identified using billing code data for laryngeal injection. Patient demographics (age, gender, profession), previous phonosurgery, date of steroid injection and follow up dates as well as VHI-10 scores were collected from the electronic medical record. Results: Twenty four patients were identified. The mean Voice HandicapIndex-10 score decreased from 23.5 pre injection to 17.8 post injection which represented a reduction of 24.3%. Vocal fold steroid injection procedure in our series was associated with one complication. Conclusion: Vocal fold steroid injection for benign lesions is a safe, well-tolerated procedure with an improvement in vocal function without surgical intervention. Steroid injection should be considered as a treatment option to avoid surgery in patients with select vocal fold lesions.

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“…With the advent of channeled endoscopes and fiber‐based lasers, a variety of laryngeal pathologies are increasingly being managed with in‐office endoscopic procedures as opposed to surgical excision under general anesthesia in the operating room (OR) 1,2 . In particular, the solid‐state potassium‐titanyl phosphate (KTP) laser is an effective and safe alternative in the treatment of a wide breadth of laryngeal diseases, including but not limited to recurrent respiratory papillomatosis (RRP), leukoplakia, polyps, mucous retention cysts, vallecular cysts, and Reinke's edema 2–6 …”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Tolerance for In‐Office Laryngeal Laser Procedures

et al. 2021

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Objectives/Hypothesis A variety of laryngeal pathologies are increasingly being managed with in‐office KTP laser (IOKTP) endoscopic procedures. The primary goal of this study was to identify patient characteristics and disease‐related features that correlated with tolerance for IOKTP. Study Design Retrospective chart review. Methods The study was a retrospective review of adult patients undergoing office‐based laryngeal laser procedures between November 2016 and December 2019 at a tertiary care center. Two blinded otolaryngologist reviewers scored videotaped recordings of IOKTP procedures and assessed severity and distribution of disease using a modified Derkay score, and evaluated procedure tolerance using a visual analog scale. Results A total of 56 patients who received IOKTP procedures for laryngeal pathology were reviewed, 42 male and 14 female, with a mean age of 61 years. Gender, age, and BMI were not correlated with tolerance. There was a moderate, negative correlation between tolerance and total number of pathological anatomic laryngeal subsites (rs(56) = −0.35, P = .01). There was a weak, negative correlation between tolerance and total modified Derkay score (rs(56) = −0.29, P = .03). The median tolerance score was lower for patients with posterior lesions (Mdn = 6.4) compared with patients with non‐posterior lesions (Mdn = 7.4), P = .04, and lower for current or former smokers (Mdn = 6.5) compared with never smokers (Mdn = 7.3), P = .04. Conclusion Patients with large disease burden or posterior lesions and patients with smoking history may exhibit poorer tolerance of IOKTP procedures, factors which can help guide pre‐procedural counseling and management decisions. Level of Evidence IV Laryngoscope, 131:E2292–E2297, 2021

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In‐Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative

Cited by 10 publications

References 33 publications

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

The role of steroid injection for vocal folds lesions in professional voice users

Factors Associated With Tolerance for In‐Office Laryngeal Laser Procedures

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