Endoscopic surgery using lasers
In Medicine and especially in Surgery, it is crucial to offer the same therapeutic effect to patients while preserving the functionality of the organ, in combination with faster healing and return to daily activities. In recent years, minimally invasive surgery in all surgical specialties has changed how diseases are treated. Developments in Otolaryngology in the field of laser-assisted functional endoscopic nasal surgery have allowed surgeons to offer patients new innovative methods for treating diseases of the head and neck. Lasers are an excellent weapon in the treatment of benign diseases and early-stage malignancies of the pharynx and larynx. A very important surgical parameter is wound healing, which depends on the accuracy of the technique, the use of zooming and lighting that provide additional possibilities in precise excisions, as they offer a different depth of field.
What are Lasers?
A laser is a device that emits one single continuous wave of electromagnetic radiation, used to cut, cauterise or “open” tissues in a wide range of diseases.
How many types are there?
Lasers produce a variety of wavelengths, with different tonality and energy levels. Today, various forms of lasers such as CO2, KTP, ND-YAG and DIODE lasers, each with different characteristics and indications, depending on the organ and the condition to which they will be applied, are available.
What has changed in Otolaryngology with the application of LASERS
LASERS revolutionised laryngeal surgery, as they allow the removal of the – benign or malignant – abnormality, depending on disease stage, without external incisions that cause disturbance to the organ’s functionality. The larynx is a multi-purpose organ, used for vocalisation, breathing and swallowing; it is essential that the surgical treatment of its conditions be done in a minimally amputating manner.
What laryngeal diseases can Lasers be applied to
To many benign conditions, such as cysts, polyps, Reinke’s oedema of the vocal cords, papillomas in children and adults, vocal cord paresis and benign tumours. In recent years, it has revolutionised the management of pharyngeal-laryngeal-hypopharyngeal tumours.
What other organs can Lasers be applied to
In the nose, they are used most often in the case of hypertrophy of the lower nasal turbinates, in hereditary diseases such as Rendu Osler disease that causes nosebleeds and in rhinophyma. In the oral cavity, they are used for performing biopsies under local anaesthesia and for removing benign and malignant lesions from the mouth and tongue.
What are the advantages of lasers?
- Minimally amputating access
- Immediate haemostasis (bloodless surgical field)
- Better visibility during manipulations thanks to zooming and lighting
- Less chance of postoperative oedema (smoother postoperative course)
In laryngeal surgery:
Α)) in benign lesions: faster healing and preservation of swallowing and speech, due to greater excision accuracy (the healthy glottal tissue is not affected)
Β)in malignant lesions: the lesion can be biopsied and removed at the same time, without requiring a tracheostomy
Surgical treatment of laryngeal cancer using Laser
Laryngeal cancer accounts for 2{d20b388198d2e905ee196862917d9f2281b0d18e47ead2dc02216a73d73a39ec} of body cancers, while 75{d20b388198d2e905ee196862917d9f2281b0d18e47ead2dc02216a73d73a39ec} of laryngeal cancers are located in the vocal chords.
The most common symptom is hoarseness, difficulty in swallowing and dry, persistent cough. Frequent predisposing factors are tobacco use, increased alcohol intake, infection with HPV virus (human papillomavirus), exposure to radiation and harmful chemicals, a diet poor in vegetables and rich in fat and meat, as well as laryngopharyngeal reflux.
As regards new techniques, head and neck surgery has marked significant progress in the last 20 years, focusing on preserving organs to the fullest extent, with the application of endoscopic surgical treatment with CO2 or KTP lasers. The main advantages of laser-assisted endoscopic surgery are the lesion’s satisfactory exposure during zooming, effective haemostasis and the minimisation of metastatic spread, the satisfactory preservation of voice quality and the avoidance of tracheostomy. The application of KTP lasers is more appropriate especially in incipient cancers or in vocal cord malformation, as it is only absorbed by the cancerous blood vessels, without affecting surrounding healthy tissue, resulting in maximum voice preservation. Another advantage of this type of Laser is that it can be applied under local anaesthesia at the clinic, in cases of laryngeal dysplasia or papillomatosis in children and adults.
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