Awake endoscopic laser surgery for early glottic carcinoma.

The objective of this study was to demonstrate the oncologic efficacy of awake endoscopic laryngeal surgery in the treatment of T1-T2 glottic carcinoma. This is a retrospective study. Seventy-one patients with early glottic carcinoma (T1a- 26, T1b- 18, T2- 27) who underwent awake flexible endoscopic laryngeal surgery under local anesthesia and mild intravenous sedation were included in the study. In 64 cases (90.1%) only endoscopic tumor ablation by Nd:YAG laser (in 32.4% of cases being preceded by diathermy snare excision) was performed, and in 7 T2 cases postoperative radiotherapy was also offered. There were no complications during or after the endoscopic surgery. Ultimate control of disease, including salvage treatment, was obtained in 67 patients (94.4%). Cure without recurrence was achieved in 60 cases (84.5%). Local control without salvage radiotherapy or/and open surgery was achieved in 64 (90.1%) patients. Larynx preservation was obtained in 66 (93.0%) cases. At 5 years from the beginning of endoscopic treatment, 74.6% of the patients were alive and free of disease. The best results were obtained in the T1a group of treated patients, all the patients being free of disease with the preserved larynx. Awake endoscopic laryngeal surgery is a safe and oncologically efficient method of treatment of early glottic carcinoma that can be considered as an alternative to the traditional approach, primarily, for patients with risks/contraindications for radiotherapy, general anesthesia, and transoral microsurgery, and also for the patients who prefer to avoid general anesthesia with its related risks and would rather choose office-based laryngeal surgery.

Laryngeal Papillomatosis: A Non-traditional Flexible Endoscopic Approach.

OBJECTIVE: To evaluate the efficacy of flexible endoscopic laryngeal surgery (FELS) using unconventional tools in the treatment of laryngeal papillomatosis (LP). METHODS: We applied FELS using forceps, diathermy snare, and Nd:YAG laser for 47 patients with LP. In 38 cases (81%), surgeries were performed under topical anesthesia with spontaneous respiration and in seven cases we used general anesthesia with superimposed high-frequency jet ventilation. In two cases, both types of anesthesia were used in different sessions. In 22 cases (46.8%), the interventions were performed as outpatient procedures. The Nd:YAG laser was used in the majority (89.4%) of cases. RESULTS: The expected result (complete eradication of the visible lesion) was obtained in all treated patients without procedure complications. Disease recurrence was established in 16 cases (34%) that led to repeated surgeries. CONCLUSIONS: FELS, using Nd:YAG laser as a main tool, is a safe and effective approach that can be a feasible alternative to the conventional approach in the treatment of LP due to possibility to avoid repeated general anesthesia with its associated risks; applicability for the patients, who have contraindications for general anesthesia and transoral microsurgery; possibility to perform the intervention in an outpatient setting that leads to essential reduction of medical costs; economy of time. Nd:YAG laser ablation, preceded by diathermy snare resection, allows reducing the time of the intervention and thermal injury of the adjacent tissues, compared to using laser alone, and can be used in bulky and obstructive lesions that present a limitation for nonablative techniques.

Flexible Endoscopic Surgery for Benign Nonepithelial Lesions of the Larynx.

Aims: The traditional approach for the management of benign laryngeal lesions is transoral microsurgery. In cases of anatomic particularities, such as insufficient cervical extension, short mandible, temporomandibular joint ankylosis etc., and contraindications for general anesthesia, transoral microsurgery is not possible. In such cases transnasal flexible endoscopic surgery under local anesthesia can be a relevant alternative. The purpose of the study was to assess the possibilities of flexible endoscopic management of benign nonepithelial lesions of the larynx. Materials and methods: Flexible endoscopic surgical interventions were performed on 315 patients with different benign nonepithelial lesions of the larynx. The larynx pathology was represented by following lesions: myxoid polyp, polypoid degeneration of vocal folds, fibrous polyp, angiofibrous polyp, angiomatous polyp, nonspecific granuloma, cyst, lipoma, neurofibroma and amyloidosis. In 97,8% of the cases interventions were performed under local anesthesia with spontaneous respiration. In 88,6% of the cases interventions were performed as outpatient procedures. Results: In all the cases the expected result was obtained - complete ablation of the visible lesion. In 7 cases repeated interventions were performed for recurrent lesions. Conclusion: Flexible endoscopic surgery is an efficient method for the treatment of benign nonepithelial lesions of the larynx, that offers a relevant therapeutic alternative, especially for the patients who have contraindications for general anesthesia or transoral microsurgery. The advantages of the method, worthy of mentionning, are positive economic effect and time economy, the intervention being possible in an outpatient setting for the majority of patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03444-z.

Flexible endoscopic laser surgery for early glottic carcinoma.

OBJECTIVE: Flexible endoscopic laser surgery (FELS) is able to overcome some limitations of traditional transoral CO2 laser surgery. The objective of this study was to assess the efficacy of FELS in the treatment of T1-T2 glottic carcinoma. METHODS: We applied FELS for 120 patients with T1-T2 glottic carcinoma. Tumour ablation was performed with Nd:YAG laser. In 76 (63.3%) cases the intervention was performed under local anesthesia. Twenty nine (24.2%) patients (T1b - 2, T2-27) underwent postoperative radiation therapy (RT). RESULTS: Successful treatment, with local control and larynx preservation, was obtained in 106 cases (88.3%), with mean follow-up of 6.4 years. More than 50% of the patients were followed-up over 5 years. CONCLUSIONS: FELS can be proposed as an alternative treatment method for patients with early glottic carcinoma. The advantages of the method include: possibility of applying treatment under local anesthesia, that allows avoiding of general anesthesia and its related risks; applicability to patients with contraindications to general anesthesia and patients with anatomic particularities, that make transoral microsurgery impossible, allowing avoidance of the laryngofissure and tracheotomy.