Angled endoscopic laryngeal surgery:: A new technique for diagnosis, surgery, and CO2 laser application

Objective: To present the development and application of a new technique to perform cold and laser laryngeal surgery. Study Design: A prospective study of 11 patients submitted for endoscopic laryngeal surgery. Methods: The technique used an endoscope with a 45degrees upward curve of its distal end; a set of angled instruments including an intraoral retractor, scissors, and forceps; and a surgical CO2 laser microtip. Eleven patients with laryngeal diseases and an indication for microsurgery underwent angled endoscopic laryngeal surgery successfully. Four patients underwent laser surgery. The CO2 laser was set between 0.5 and 2.0 W at normal exposure times and delivered distally through a lens composition within the angled handpiece. Results: The lesions were precisely treated with minimal bleeding. The excised areas healed promptly, and no excessive scarring from laser application has been observed in a 5-month postoperative video laryngoscopy follow-up. No major morbidity and no worsening of the voice occurred in any of the patients. A wide-angle view with a greater depth of field than the surgical microscope and a three-dimensional view were obtained as a result of the use of an endoscope in this technique; visualization of undersurfaces and an unobstructed visual field have been a result of the endoscope use as well. A beam waist ranging between 200 and 350 mum was produced. Conclusions: The approach described in the present study may help the laryngologist overcome some of the shortcomings and difficulties in laryngeal surgery, especially when dealing with patients in whom adverse anatomy and certain clinical conditions contraindicate microlaryngoscopy. Because of a delivery of laser waves at shorter distances from the lesions, a more precise tissue exeresis with minimal disturbances to the vocal folds might be accomplished as a result of the smaller beam waist produced. Distal delivery of laser waves also reduces the risks of stray laser beam striking nontargeted areas. Long-term studies with a larger number of patients are necessary.