Laser debulking of obstructing laryngeal tumours

Robson, Andrew; Herrema, I.; Stafford, F. W.

doi:10.1111/j.1365-2273.1994.tb01263.x

Cited by 9 publications

(18 citation statements)

References 4 publications

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“…Even though the fatalities did not appear to be directly related to endolaryngeal obstruction, these fatalities demonstrate that the C02 laser debulking procedure should be considered a major surgical procedure with a non-negligible mortality. This is further documented by the fact that 1 patient in our series, as well as 1 in the series by Robson et al, 11 experienced aspiration pneumonia after the C02 laser debulking procedure.…”

Section: Discussionsupporting

confidence: 77%

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Laccourreye¹,

Lawson

Muscatello³

et al. 1999

Ann Otol Rhinol Laryngol

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The results of the carbon dioxide (CO2) laser debulking procedure for obstructing endolaryngeal carcinoma were analyzed in terms of efficiency, complications, secondary tracheotomy rate, and peristomal recurrence rate in a series of 50 patients consecutively managed at our department. The CO2 laser was used to reestablish a safe airway without resorting to tracheotomy and without performing a transoral resection. Our series included 42 patients in a pre-definitive treatment group (group 1) and 8 patients in a palliation group (group 2). Complications included death, pneumonia from inhalation, and cutaneous burns in 2 patients, 1 patient, and 1 patient, respectively. Thirty-two percent of patients required a repeat laser treatment to maintain the airway. Overall success rates of 92.8% and 87.5% were achieved in group 1 and group 2 patients, respectively. None of the variables under analysis could predict the success of the CO2 laser debulking procedure. The overall incidences for secondary tracheotomy were 4.7% and 0% in group 1 and group 2 patients, respectively. Peristomal recurrence was not encountered in patients managed with definitive therapy with curative intent.

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Section: Discussionsupporting

confidence: 77%

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Laccourreye¹,

Lawson

Muscatello³

et al. 1999

Ann Otol Rhinol Laryngol

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“…20 The experience and efficiency of primary laser debulking of laryngeal tumors, which has caused airway obstruction, has resulted in the patient being able to be evaluated and allowed to give informed consent to further management. [21][22][23][24][25] Intubation and partial excision of the tumor offer several advantages over emergency laryngectomy. An orderly workup of the patient is possible.…”

Section: Intubation and Debulking Of Tumormentioning

confidence: 99%

Treatment of the Patient with Upper Airway Obstruction Caused by Cancer of the Larynx

Bradley

1999

Otolaryngol.--head neck surg.

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The treatment of a patient with imminent airway obstruction caused by a malignant tumor of the larynx is an uncommon clinical problem. These cases need to be evaluated, diagnosed, and managed with care, skill, speed, and above all, appropriateness of intervention. Three methods are available to control the airway: tracheostomy, emergency laryngectomy, and controlled tracheal intubation with or without tumor debulking. Two groups of patients had their airways managed either by tracheostomy and delayed elective surgery or by emergency laryngectomy. There was no survival advantage between the groups, and no increased risk of stomal recurrence was demonstrated. If time permits, the patient is considered suitable, and adequate anesthetic and surgical instrumentation is available, it is currently recommended that the obstructing laryngeal tumor be debulked by cold-steel or, preferably, CO2 laser and that the emergency situation be stabilized and the definitive treatment of the patient be converted to an elective procedure without the need to create a tracheostomy.

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“…[9][10][11][14][15][16]18,20,22,23,[29][30][31] Other described cordectomies for more advanced laryngeal cancers (including pT3 or pT4 lesions) (n = 4), laser debulking of obstructing airway tumors (n = 4), partial laryngectomies for supraglottic or glottic lesions (n = 2), laser excision of glottic or supraglottic neoplasms of the posterior laryngeal compartment (n = 1), and other indications (biopsy, excision, airway reestablishment and debulking) (n = 1). 12,13,17,19,21,[24][25][26][27][28]32,33 Regarding ventilation, most authors (n = 12) employed endotracheal intubation (ETI), while 2 authors described the use of both ETI and jet ventilation (JV), and 1 author described the use of ETI, JV, or spontaneous respiration (SR). [9][10][11]13,14,[16][17][18]22,24,[26][27][28]31,33 Various preoperative safety strategies we reported, including the use of laser-safe or laser-protected endotracheal tubes (ETT) (n = 11), limited O 2 content in inhaled gases to mitigate the risk of airway fires (n = 2), moistened drapes and eye pads to protect patients (n = 3), and protective eyewear for operating room staff (n = 2).…”

Section: Tolms For Oncologic Resectionsmentioning

confidence: 99%

“…12,13,17,19,21,[24][25][26][27][28]32,33 Regarding ventilation, most authors (n = 12) employed endotracheal intubation (ETI), while 2 authors described the use of both ETI and jet ventilation (JV), and 1 author described the use of ETI, JV, or spontaneous respiration (SR). [9][10][11]13,14,[16][17][18]22,24,[26][27][28]31,33 Various preoperative safety strategies we reported, including the use of laser-safe or laser-protected endotracheal tubes (ETT) (n = 11), limited O 2 content in inhaled gases to mitigate the risk of airway fires (n = 2), moistened drapes and eye pads to protect patients (n = 3), and protective eyewear for operating room staff (n = 2). 10,13,14,[16][17][18]21,22,24,31,33 Various intraoperative strategies were also outlined, such as subepithelial hydrodissection and bronchoscopy to clean debris following the procedure.…”

Section: Tolms For Oncologic Resectionsmentioning

confidence: 99%

Strategies for CO₂ Laser Use in Laryngeal Microsurgery: A Systematic Review

Landry,

Sedillot‐Daniel,

Ayad

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveWe aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.Data SourcesA systematic review of publications indexed in Medline, Embase, and EBM reviews‐Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted.Review MethodsRecords obtained from the search strategy were assessed for eligibility in a 2‐step process by 2 independent researchers using the Covidence software.ResultsAmong 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow‐up).ConclusionThe results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.

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Laser debulking of obstructing laryngeal tumours

Cited by 9 publications

References 4 publications

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Treatment of the Patient with Upper Airway Obstruction Caused by Cancer of the Larynx

Strategies for CO₂ Laser Use in Laryngeal Microsurgery: A Systematic Review

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Laser debulking of obstructing laryngeal tumours

Cited by 9 publications

References 4 publications

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience

Treatment of the Patient with Upper Airway Obstruction Caused by Cancer of the Larynx

Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review

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Product

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Strategies for CO₂ Laser Use in Laryngeal Microsurgery: A Systematic Review