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

Karkos, Petros D.; Koskinas, Ioannis; Triaridis, Stefanos; Constantinidis, Jannis

doi:10.1177/0145561320951681

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…Despite the significant advantages of CO 2 lasers, such as improved hemostasis and shorter operating time, they pose various risks that demand attention to ensure safety for both patients and operating room staff. [1][2][3][4][5] While this review highlights a generally good safety profile for CO 2 laser TOLMS, it also reveals significant potential for laser-related complications, with rates of unwanted facial burns up to 3% in some studies. 13,58,73,102 Challenges to safe laser use span individual, team, and systemic levels.…”

Section: Barriers and Challenges To Safe Laser Use In Tolmsmentioning

confidence: 99%

“…These advantages include improved hemostasis, precise tissue ablation, minimal collateral damage, and improved efficiency. [1][2][3] However, the use of lasers also entails inherent risks that require adequate safety measures to mitigate potential intraoperative complications such as facial and mucosal burns, atmospheric contamination, and airway fires, as well as postoperative complications such as emphysema, vocal fold scarring, and glottic incompetence. [3][4][5] Despite the widespread use of CO 2 lasers in laryngeal TOLMS, there are currently no official recommendations or guidelines addressing standard perioperative practices and safety measures.…”

mentioning

confidence: 99%

“…From tumor resection to the repair of laryngotracheal fistulas, lasers have shown their utility across a wide spectrum of applications and notable advantages over conventional cold surgical techniques. These advantages include improved hemostasis, precise tissue ablation, minimal collateral damage, and improved efficiency 1‐3 . However, the use of lasers also entails inherent risks that require adequate safety measures to mitigate potential intraoperative complications such as facial and mucosal burns, atmospheric contamination, and airway fires, as well as postoperative complications such as emphysema, vocal fold scarring, and glottic incompetence 3‐5 …”

mentioning

confidence: 99%

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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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Section: Barriers and Challenges To Safe Laser Use In Tolmsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Однако разрез первых лазерных аппаратов, производимый за счет непрерывной подачи энергии инфракрасной части оптического спектра, отличался протяженной зоной коагуляционных изменений, что требовало избирательности применения высокоэнергетического хирургического инструмента для снижения рубцевания тканей в отдаленном периоде [14,15]. За более чем 60-летнюю историю лазерной медицины аппараты значительно изменились и приобрели надежную систему охлаждения, процессор и микроманипулятор для работы в дистантном режиме [16]. Современные компьютеризированные СО 2 -лазеры запрограммированы на работу в различных режимах в зависимости от хирургической задачи.…”

Section: материалы и методыunclassified

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

Krivopalov,

Shamkina,

Glushchenko

2023

Consilium Medicum

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Background. The treatment of chronic diseases of the larynx is an urgent issue. Chronic larynx masses account for up to 5570% of the upper respiratory tract proliferative diseases. The incidence of vocal apparatus disorders is stable due to increased load on the vocal apparatus, neuro-emotional stress, non-compliance with voice hygiene (smoking, alcohol consumption), nasal and pharyngeal inflammatory diseases, sensibilization, and gastrointestinal disorders. Dysphonia, voice timbre changes, and vocal fatigue are presented in 712% of otorhinolaryngologist patients. Delayed treatment of chronic larynx diseases can lead to upper respiratory obstruction, reduced exercise and self-care tolerance, and disablement in people with voice and speech professions. Aim. To address current treatment methods for chronic diseases of the larynx. Modern surgical and non-surgical treatments of chronic larynx diseases aim to restore voice quality and respiratory function. Over the past 50 years, laser-assisted phonosurgery has gained popularity due to the many benefits of biological tissue exposure to electromagnetic energy and low rates of intra- and postoperative complications. Materials and methods. The literature review was performed using electronic medical libraries and professional printed papers. According to local and foreign data, laryngeal laser surgery is highly precise, minimally invasive, associated with no blood loss, and highly effective. Historically, CO2 laser has been used for the longest time in laryngeal surgery. Modern medical technology has recently introduced surgical systems with novel technicalities for clinical use. In such devices, the laser energy is transmitted through a flexible optical fiber instead of a mirror system, as in the CO2 laser, which has made new surgical high-energy systems more affordable for equipping medical institutions. Currently, the following fiber-optic laser systems are most often used to treat chronic diseases of the larynx: potassium-titanyl-phosphate, diode laser, and "blue" laser with a wavelength of 445 nm. Results. The literature review and analysis of surgical treatment outcomes using fiber-optic laser devices in patients with chronic larynx diseases showed high safety and effectiveness of modern treatments, providing fast recovery of voice and respiratory function. Conclusion. The development of laser devices, including domestic ones, with new wavelengths, makes it possible to work in contact mode in an inert gas environment, which opens up new opportunities for phonosurgery.

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“…однако до сих пор остается дискутабельным вопрос о выборе типа лазера и его параметров при хирургическом лечении заболеваний гортани [9][10][11][12].…”

Section: Introductionunclassified

Use of 445 nm laser in laryngeal surgery: experimental study

Krivopalov¹,

Шамкина²,

Il'ina³

et al. 2022

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Introduction. The problem of phonosurgery remains relevant today since the prevalence of benign and tumor-like laryngeal lesions is up to 55%–70% among diseases of the upper respiratory tract. Photoangiolytic lasers are actively used among laser systems in phonosurgery today. A new 445 nm surgical laser (TruBlue, A.R.C. Laser Company), having a high hemostatic and resection effects, was certified for the medical market in 2018. TruBlue laser operation is possible in an atmosphere of inert gas (helium) by connecting the optional Flow Control unit. To date, there are very few works in foreign and Russian literature devoted to the use of that laser device in ENT practice, particularly, in laryngology. Objective. To select the optimal 445 nm laser mode for use in phonosurgery based on an experimental study of biological material. Material and methods. An experimental study was conducted on a model of the larynx (chicken muscle tissue) using a 445 nm laser in contact constant and pulsed modes, including an atmosphere of an inert gas (helium). The zones of destruction, coagulation necrosis, and ischemia were measured by histological examination using a morphometry system. The total number of experiments was 142, the total number of micro-preparations studied was 284. Results. While working in continuous wave mode, we received an extensive zone of thermal exposure, which in clinical practice correlates with deep damage of the vocal fold and violation of its vibratory function. This confirms the axiom that the optimal mode for laryngeal surgery is a pulsed one. According to the evaluation results of the pulse mode at standard laser settings (without helium supply), the parameters with the smallest pause between pulses—that is, 8 W pulse 10–20 ms, 9–10 W pulse 10 ms with a pause of 150 ms—were the most optimal for practical activity in terms of combined resection and coagulation effect. These parameters are acceptable for use in phonosurgery since the maximum destruction zone does not exceed 600 nm. While working in an inert gas atmosphere, we recommend using a laser at a power of 6–8 W with a pulse duration of 10 ms and a pause of 100–130 ms; with an increase in the pulse, lengthen the pause 6–7 W 20 ms 120–130 ms, 8 W 20 ms with a pause of 130 ms. Conclusion. During the experiment, blue laser showed high resection and coagulation effects. According to the results of the study, the parameters of laser exposure were obtained, which are optimal for the surgical treatment of benign and tumor-like laryngeal lesions.

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

Cited by 4 publications

References 12 publications

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

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

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

Use of 445 nm laser in laryngeal surgery: experimental study

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

Cited by 4 publications

References 12 publications

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

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

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

Use of 445 nm laser in laryngeal surgery: experimental study

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

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