High Radiofrequency Surgery and Chromoendoscopy: A Novel Surgical Technique for the Treatment of Respiratory Papillomatosis.

Recurrent Respiratory Papillomatosis is a highly recurrent and residual disease. The use of indigo-carmine chromoendoscopy increases the early detection of nonvisible disease and reduces the possibility of leaving residual lesions. The best chances of papillomatosis being eradicated depend upon a surgical shallow epitheliolysis approach applied to patients who have never been surgically damaged before. We developed a novel surgical technique based upon the use of a time controlled High Radiofrequency (HRF) energy output. We applied a three-step bloodless HRF-surgical technique, that is, epitheliolysis, angiolysis and peeling without the aid of adjunct therapies. It acts according to differences in the water density of the tissues. We use it to remove the epithelial viral reservoir thus preserving subepithelial layers. For this purpose, we designed and manufactured a custom-made HRF electrodes set for office and O.R. use. From 2005 to 2018, 39 patients (100%) with recurrent respiratory papillomatosis participated in the present prospective work. Twenty-five (64,10%) achieved complete postsurgical remission, 6 (15,38%) were lost to follow up, and 8 (20,51%) present partial remissions. Thirty-six patients had laryngeal papillomatosis. Follow-up was possible in 30 of the 36 patients with laryngeal papillomatosis with a success remission rate of 83,33% (25 of 30). Eleven of those 36 (30,55%) entered this study without previous surgical treatment and 9 of 11 (81,81%) were cured. Indigo-carmine chromoendoscopy, a visualization solution for papillomatosis detection, together with a bloodless HRF-surgical technique proved to be effective tools to eradicate papillomatosis. Voice restoration to normal or near normal levels was achieved in all patients.

Chromoendoscopy associated with endoscopic laryngeal surgery: a new technique for treating recurrent respiratory papillomatosis.

OUTLINE: Chromoendoscopy is a dye enhancement technique that uses epithelial tissue dyeing for assessing any changes in it by determining its characteristics and eventually to improving mucosal lesions detection at endoscopy. Currently with the addition of a joint use of rigid endoscopes and video systems at surgery, visualization of the larynx and trachea areas significantly improved with wide angle viewing. However, in certain diseases, such as laryngeal papillomatosis, certain conditions were overlooked by these approaches and with the likelihood of postoperative early relapse. With the addition of chromoendoscopy to endoscopic laryngeal surgery, we were able to increase the ability to recognize intraoperatively inconspicuous lesions, improve lesion limit visualization, observe in detail their surfaces, and determine as well the existence of residual lesion if any after surgical removal. OBJECTIVES: To prove the helpfulness of chromoendoscopy in otolaryngology as an innovative diagnostic technique associated with laryngeal endoscopical surgery. MATERIALS AND METHODS: The present study uses contrast dyeing agents such as indigo carmine as endoscopic tissue staining and, incidentally, which is the most widely used detection method in gastroenterology. The dye fills the interstices, highlighting irregularities, such as depressions and elevations in architecture. RESULTS: This diagnostic enhancing technique was used with six patients who presented recurrent laryngeal papillomatosis. We committed ourselves to get the most out of the intraoperative diagnostic yield and reduce the relapse likelihoods in all cases. CONCLUSION: Chromoendoscopy joined with endoscopic laryngeal surgery is an excellent intraoperative diagnostic approach in the management of laryngeal invasive conditions such as laryngeal papillomatosis.