Microscopic Surgery with Coblation for the Treatment of Benign Laryngeal Lesions: A Case Report

Abstract

Background: Coblation based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Coblation technology provides ablation, resection, coagulation of soft tissue and hemostasis of blood vessels in one convenient surgical device. Coblation technology can be used in the larynx and trachea for removing or debulking sessile polyps, lesions or tumors. Minimally invasive coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalization. Aim: This case study aims to explore the advantages of coblation combined with microscopy to treat benign laryngeal lesions. Case report: We report the case of laryngeal papilloma treated with minimally invasive coblation resection. Fiberoptic laryngoscopy was done pre-operatively and that showed papillomatous mass at anterior half of right vocal cord involving inferior surface and also extending upto anterior commissure. Mobility of both vocal cords was normal. On the basis of the above findings with normal vocal cords mobility, the microlaryngeal surgery with coblation was planned. After complete pre-op work up, the patient underwent trans-oral microscopic coblation excision of mass under general anaesthesia. Power level was set to 7 for ablation and 3 for coagulation. The PROcise TM LW Plasma Wand system was chosen such that it was malleable to reach the papillomatous mass without obstructing the vision. It was totally excised and sent for histopathology examination. Post-operatively after four hours, he was able to take normal diet comfortably. He was followed up after 10 days. Histopathological report confirmed the diagnosis of papilloma. Check laryngoscopy was performed after 3 weeks. Laryngeal examination was absolutely normal with almost normal vocal cords and normal voice post-operatively. Conclusion: Microscopic surgery with coblation has the advantages of less bleeding, short procedure duration, increased completion rate and few complications.

Comparative study on surgical outcome for benign vocal cord lesions by conventional method versus coblation

“…Chauhan et al and Qinfeng et al in their case report on treatment of laryngeal papilloma with coablation have stated that intraoperatively there was less bleed with shorter surgery duration. 17,18 Qinfeng have also stated that there is less damage to surrounding tissue while using coablation. Similarly in this, intraoperatively less blood loss is seen in coblation group with decrease in total surgery duration in the same.…”

“…Like that of Michael et al, Surya et al, Emily et al and Ayatullah et al in their study on impact of voice disorders and microlaryngeal surgery on psychological profiles. [17][18][19][20] There was a moderate relation between dysphonia and anxiety and depression according to the voice handicap index. In current study there was a overall decrease in the VHI total scores postoperatively.…”

Challenges in removal of congenital nasopharyngeal teratoma in a 5 day old neonate

“…4 The main treatment of teratoma is complete surgical resection with rare recurrences as reported in literature. 5 Coblation technique has been traditionally used for varied conditions like adenoidectomy, tonsillectomy, channelling of palate. At the same time, coblation has been now proved to be an effective method for resection of selected head and neck malignancies.…”

“…6 Coblation creates plasma mediated dissociation of molecular bonds within the tissues with minimal thermal damage with additional advantage of coagulation so as to limit blood loss. 5 Procise Plasma Wand used in coblation technique has excellent features which includes an enhanced flatscreen active electrode configuration that enables efficient bipolar ablation and coagulation during surgical procedures and a long, low-profile malleable wand shaft that allows increased surgical field visualization, adjustable to individual anatomy. 5 As nasopharyngeal teratomas are often encapsulated or pseudo-encapsulated and not infiltrating, coblation technique was chosen which facilitates dissection of the teratoma from surrounding tissue structures.…”

“…5 Procise Plasma Wand used in coblation technique has excellent features which includes an enhanced flatscreen active electrode configuration that enables efficient bipolar ablation and coagulation during surgical procedures and a long, low-profile malleable wand shaft that allows increased surgical field visualization, adjustable to individual anatomy. 5 As nasopharyngeal teratomas are often encapsulated or pseudo-encapsulated and not infiltrating, coblation technique was chosen which facilitates dissection of the teratoma from surrounding tissue structures. 6 Bycoblation, extensive dissection of tissue planes could be avoided which is a tough prospect in a 5 day old baby.…”