The versatile contact Nd:YAG laser in head and neck surgery: an in vivo and clinical analysis

1064 nm Nd:YAG laser treatment of melanocytic nevi of the external auditory canal: a retrospective study of 15 cases

The aim of this study was to evaluate the efficacy and safety of 1064 nm neodymium-doped yttrium-aluminum-garnet laser treatment of melanocytic nevus of the external auditory canal. Retrospective chart review of 15 patients operated by 1064 nm Nd:YAG laser in single center. Data from charts and video documentation were collected and analyzed. Between November 2017 and November 2018, 15 patients underwent 1064 nm Nd:YAG laser treatment for melanocytic nevus of the external auditory canal were analyzed in the study. The size of melanocytic nevus ranged from 4 to 8 mm in diameter. A gross total removed was achieved in all cases. Two patients received two sessions of Nd:YAG laser treatments, and the remaining thirteen patients received only one session. After laser treatment, wounds healing well and the average epithelialization time was 2.3 weeks. The mean follow-up was 12 months. There were no recurrence and adverse side effects in all cases. This research supports the use of 1064 nm Nd:YAG laser as a safe and efficacious treatment for melanocytic nevus of the external auditory canal.

Outcomes of laser thermal therapy for recurrent head and neck cancer

Objective: To review the outcomes of a phase II study using laser-induced thermal therapy (LITT) as a palliative treatment for 106 patients with recurrent head and neck tumors.

Study Design: Retrospective study.

Setting: Tertiary hospital in the United States.

Subjects and Methods: The primary endpoints were tumor response and survival. Prognostic values were assessed by the Kaplan-Meier method.

Results: The best results were seen in oral cavity tumors, in which mean survival was 29.1 months, as compared to neck tumors (mean 14.4 ± 6.9 months; range 7.5-20.7 months; with a 95% confidence interval). Further analysis showed that clinical factors such as gender, smoking, and alcohol use were not indicators of poor prognosis, whereas neck disease and tumor stage at first treatment were relevant factors.

Conclusion: In this study, 40 out of 106 patients treated by LITT remained alive at the end of our follow-up, and a complete response was seen in 24 (22.6%) patients. The highest response rate was seen in oral cavity tumors, which suggests that tumor location at this site may be a predictor of favorable outcome with LITT.

Comparison of Nd:YAG Surgical Laser and Remorgida Bipolar Electrosurgery Forceps for Canine Laparoscopic Ovariectomy

OBJECTIVE

To investigate and compare technique, surgical time, and complications of canine laparoscopic ovariectomy using Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps.

STUDY DESIGN

Randomized, prospective clinical trial.

ANIMALS

Female dogs (n=40) for elective ovariectomy.

METHODS

Dogs had bilateral ovariectomy with one ovary randomly assigned to removal by use of Nd:YAG surgical laser with a 600 mum optical fiber in contact mode and the other ovary to removal by use of a Remorgida forceps (featuring bipolar electrocoagulation with simultaneous sharp resection). Duration of predetermined surgery intervals and complications were compared between techniques. Additionally, the effects of several intraoperative variables on surgical time were evaluated.

RESULTS

Ovariectomy by use of Remorgida forceps required significantly less time than laser ovariectomy but intraoperative hemorrhage was not reduced. Surgical time was significantly increased in obese dogs, depending on the amount of fat in the ovarian ligament. Intraoperative hemorrhage had no significant influence on surgical time.

CONCLUSION

Both ovariectomy techniques were effective but the Remorgida forceps can be used as a relatively inexpensive, stand-alone device that decreases surgical time compared with Nd:YAG laser ovariectomy.

CLINICAL RELEVANCE

Novel techniques, such as laser and combined bipolar electrosurgical and cutting forceps aim to reduce surgery duration, complication rates and recovery time in laparoscopic surgery.

Combined cytoreductive laser therapy and immunotherapy for palliation of metastatic renal cell carcinoma to the head and neck

Interleukin-2 (IL-2) remains the mainstay of treatment for metastatic renal cell carcinoma (RCC), but minimally invasive surgical techniques have provided new options for the combined treatment of RCC. Two patients with metastatic RCC to the head and neck treated by combined laser-induced thermal therapy and IL-2 were described in this case report. Both patients had an extended survival compared to the historical survival of 10 months for metastatic RCC but eventually succumbed to progressive disease. The authors' initial experience with metastatic RCC suggests that laser thermoablation and immunotherapy in selected patients with metastatic RCC is warranted as a palliative treatment, but a larger study with long-term follow-up is necessary to determine the effectiveness of this approach.

Parotid Surgery Using Nd:YAG Laser Contact Tips: Clinical Assessment of Perioperative Facial Nerve Function

OBJECTIVE

The objective of this paper is to review 51 consecutive contact Nd:YAG laser parotidectomies to determine perioperative outcomes and complications related to the facial nerve and the use of the laser tips.

BACKGROUND DATA

Parotid surgery is mostly performed with scalpel or scissors, techniques that may put the facial nerve at risk for injury due to brisk bleeding and imprecise dissection. Even though previous experiences with Nd:YAG lasers in surgery had raised concerns of energy dispersion, the contact sapphire tips used in this series allowed accurate precise dissection and hemostasis, limiting complications.

MATERIALS AND METHODS

Close facial nerve dissection was done at 8-12 watts, for an average total of 8,000-12,000 joules per case.

RESULTS

No significant or permanent facial nerve complications resulted from the use of the laser tips, except for expected transient and reversible postoperative ipsilateral marginal mandibular nerve paresis observed in 43% of the patients-less than the generally quoted 50% expected after uneventful lateral lobe parotidectomy.

CONCLUSION

This review concludes that the contact Nd:YAG laser may offer significant technical and safety advantages, and no direct associated complications in the dissection and preservation of the facial nerve in parotidectomy.

Neodymium YAG contact laser in the treatment of cancer of the mobile tongue

The aim of this study was to evaluate the usefulness of a contact neodymium YAG laser for the treatment of squamous cell carcinoma (SCC) of the mobile tongue in 35 patients. The TNM stage and histologic grade were as follows: T1, n = 20; T2, n = 11; T3, n = 4; and N0, n = 33; N1, n = 2; G1, n = 20; G2, n = 10; and G3, n = 5. The surgical treatment consisted of a hemiglossectomy or resection with adequate margins in 28 cases, and an ipsilateral neck dissection was also performed in 7 patients. Radiotherapy to a mean tumor dose of 62-64 Gy and an elective dose of 50 Gy to the cervical lymph nodes was given to 14 patients. The radiotherapy was preoperative in 12 patients and postoperative in 2. Tongue resection was easily performed using the contact neodymium YAG laser, with a mean operation time of 31 min and intraoperative bleeding varying from negligible to 100 cm3. During postoperative follow-up no major complications occurred: cases with minor hemorrhage were easily controlled on the ward and 1 patient had a bleed on the 14th postoperative day necessitating hospitalization. The resection was histologically radical in all cases. During follow-up one patient had a local recurrence (T2N0, G3) and four failed in the neck (T1N0 G2, T1N0 G2, T1N0 G2, T2N0 G2), three of whom were successfully salvaged with a neck dissection and radiotherapy. One patient with osteoradionecrosis was diagnosed and treated curatively. Two patients died of their tongue cancer (T2N0 G3, T2N0 G2), 1 died from a second primary tumor (T2N0 G1) and 2 of intercurrent disease with no evidence of cancer; 30 patients (86%) are still alive with no evidence of disease. The function of the tongue in all patients in this sample was good to satisfactory. The major complaint was xerostomia in the irradiated patients. In conclusion, the contact neodymium YAG laser appears to be suitable for resection of T1-T2 SCCs of the oral tongue. In this limited patient sample T stage or grade did not predict failures in the neck. Biologic predictive markers need to be evaluated.