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Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2024; 38:1227-1236. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
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Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Zhang H, Li Y, Zhu X, Zhao X, Cong L. CT imaging-based nomogram for predicting early-stage glottic cancer recurrence following transoral laser microsurgery. J Cancer Res Ther 2024; 20:1201-1207. [PMID: 39206982 DOI: 10.4103/jcrt.jcrt_2625_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/01/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To explore the differences between clinical features and computed tomography (CT) findings of early-stage glottic cancer (EGC) with or without recurrence after transoral laser microsurgery (TLM) and to establish a preoperative nomogram to predict postoperative recurrence. METHODS The clinical and CT features of 168 consecutive patients with EGC with or without recurrence were analyzed retrospectively. Multivariate logistic regression analysis was used to determine the independent predictors of recurrence. A nomogram was constructed to preoperatively predict recurrence. To assess the nomogram's performance, the C-index and calibration plot were used. RESULTS EGCs with and without recurrence differed significantly in T-stage, depth, and normalized CT values in the arterial phase (NCTAP) and venous phase (NCTVP) (all P < 0.05). T-stage, depth, and NCTVP were independent predictors of recurrence in EGCs (all P < 0.05). The C-index (0.765, 95% confidence interval: 0.703-0.827) and calibration plot showed that the nomogram has good prediction accuracy. Nomograms based on T-stage and CT variables provided numerically predicted recurrence rates and were better than those based on only T-stage (C-index of 0.765 vs. 0.608). CONCLUSIONS Using clinical and CT variables, we developed a novel nomogram to predict the recurrence of EGC before TLM, which may be a potential noninvasive tool for guiding personalized treatment.
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Affiliation(s)
- Huanlei Zhang
- Department of Radiology, Yidu Central Hospital of Weifang, Weifang, China
| | - Yuanyuan Li
- Department of Radiology, Yidu Central Hospital of Weifang, Weifang, China
| | - Xuelin Zhu
- Department of Ultrasound, Qingzhou People's Hospital, Qingzhou, China
| | - Xiuli Zhao
- Radiology, Qingzhou People's Hospital, Qingzhou, China
| | - Lin Cong
- Department of Medical Imaging Interventional, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China
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González-Herranz R, Martínez-Ruiz-Coello M, Hernández-García E, Miranda E, García-García C, Arenas O, Plaza G. Transoral Flexible Laser Surgery of the Larynx with Blue Laser. J Clin Med 2023; 12:5250. [PMID: 37629292 PMCID: PMC10456013 DOI: 10.3390/jcm12165250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. MATERIAL AND METHODS A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. RESULTS A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. CONCLUSIONS The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.
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Affiliation(s)
- Ramón González-Herranz
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
- Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, 28023 Madrid, Spain
| | - Mar Martínez-Ruiz-Coello
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
| | - Estefanía Hernández-García
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
| | - Estefanía Miranda
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
| | - Cristina García-García
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
| | - Oscar Arenas
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
- Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, 28023 Madrid, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain; (R.G.-H.); (M.M.-R.-C.); (E.H.-G.); (E.M.); (C.G.-G.); (O.A.)
- Department of Otorhinolaryngology, Hospital Universitario Sanitas La Zarzuela, 28023 Madrid, Spain
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Mayo-Yánez M. In Reference to Transoral Robotic Surgery for Cancer of the Soft Palate Posterior Surface. EAR, NOSE & THROAT JOURNAL 2023; 102:NP99-NP100. [PMID: 33570427 DOI: 10.1177/0145561321993591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- M Mayo-Yánez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
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Kozhanov AL, Kozhanov LG, Kravtsov SA, Sdvizhkov AM. [Modern aspects of organ-preserving surgery for laryngeal cancer]. Vestn Otorinolaringol 2022; 87:44-50. [PMID: 35605271 DOI: 10.17116/otorino20228702144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.
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Affiliation(s)
- A L Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
| | - L G Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Kravtsov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,Peoples' Friendship University, Moscow, Russia
| | - A M Sdvizhkov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
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Fischer J, Özen AC, Ilbey S, Traser L, Echternach M, Richter B, Bock M. Sub-millisecond 2D MRI of the vocal fold oscillation using single-point imaging with rapid encoding. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2021; 35:301-310. [PMID: 34542771 PMCID: PMC8995286 DOI: 10.1007/s10334-021-00959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The slow spatial encoding of MRI has precluded its application to rapid physiologic motion in the past. The purpose of this study is to introduce a new fast acquisition method and to demonstrate feasibility of encoding rapid two-dimensional motion of human vocal folds with sub-millisecond resolution. METHOD In our previous work, we achieved high temporal resolution by applying a rapidly switched phase encoding gradient along the direction of motion. In this work, we extend phase encoding to the second image direction by using single-point imaging with rapid encoding (SPIRE) to image the two-dimensional vocal fold oscillation in the coronal view. Image data were gated using electroglottography (EGG) and motion corrected. An iterative reconstruction with a total variation (TV) constraint was used and the sequence was also simulated using a motion phantom. RESULTS Dynamic images of the vocal folds during phonation at pitches of 150 and 165 Hz were acquired in two volunteers and the periodic motion of the vocal folds at a temporal resolution of about 600 µs was shown. The simulations emphasize the necessity of SPIRE for two-dimensional motion encoding. DISCUSSION SPIRE is a new MRI method to image rapidly oscillating structures and for the first time provides dynamic images of the vocal folds oscillations in the coronal plane.
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Affiliation(s)
- Johannes Fischer
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ali Caglar Özen
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Consortium for Translational Cancer Research Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Serhat Ilbey
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Louisa Traser
- Freiburg Institute for Musicians' Medicine, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Bernhard Richter
- Freiburg Institute for Musicians' Medicine, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13081895. [PMID: 33920824 PMCID: PMC8071167 DOI: 10.3390/cancers13081895] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. The recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Evidently, the investigated imaging modalities are generally unsuitable for deep margin assessment, and, therefore, inadequate to guide resection in advanced laryngeal disease. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages. Abstract Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. Treatment consists of unimodal therapy through surgery or radiotherapy in early staged tumors, while advanced stage tumors are generally treated with multimodal chemoradiotherapy or (total) laryngectomy followed by radiotherapy. Still, the recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review, we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Narrow-band imaging (NBI) and autofluorescence (AF) are established tools for early detection of laryngeal cancer. Nonetheless, their intraoperative utility is limited by an intrinsic inability to image beyond the (sub-)mucosa. Likewise, contact endoscopy (CE) and optical coherence tomography (OCT) are technically cumbersome and only useful for mucosal margin assessment. Research on fluorescence imaging (FLI) for this application is sparse, dealing solely with nonspecific fluorescent agents. Evidently, the imaging modalities that have been investigated thus far are generally unsuitable for deep margin assessment. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages.
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Li X, Li J, Cui X, Hu X, Yu P, Sun G. The Thermal Damage of Canine Vocal Fold by CO 2 Laser Under Different Laser Emission Mode. EAR, NOSE & THROAT JOURNAL 2021; 101:17S-23S. [PMID: 33719628 DOI: 10.1177/0145561321999262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to review the differences between continuous wave (CW) and UltraPulse (UP) on thermal damage of the laser with different power. METHODS Four adult beagle dogs underwent transoral laser microsurgery (TLM) using CO2 laser. The laser emission mode and power was CW (3 W, 5 W, and 8 W) and UP (3 W and 5 W), respectively. The tissue from 4 animals was evaluated histologically on postoperative days 1 and 3. The thermal damage of the laser was measured using slide scan system via SlideViewer version 1.5.5.2 software. RESULTS All dogs underwent TLM uneventfully. Under microscope examined, the laser damage area was composed of 2 parts: the vaporized zone (VPZ) and thermal damage area. The thermal damage area can be divided into thermal coagulative necrosis area (TCN) and hydropic degeneration area. The width of VPZ and TCN in UP mode was less than that in CW mode (P < .01). The data indicate that lower laser power created less thermal damage (P < .01). In addition, the width of VPZ on postoperative day 3 was less than that on postoperative day 1 (P < .01). CONCLUSION CO2 laser with UP and lower power could decrease the laser thermal damage and may offer more prompt wound healing.
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Affiliation(s)
- Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jiaying Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Preclinical experience with a novel single-port platform for transoral surgery. Surg Endosc 2021; 35:4857-4864. [PMID: 33712940 PMCID: PMC8263430 DOI: 10.1007/s00464-021-08420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/23/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND We investigated a novel minimally invasive surgical platform for use in the oropharynx, hypopharynx, and larynx for single-port transoral surgery used in concert with standard transoral laryngeal and pharyngeal instrumentation. METHODS The preclinical investigational device by Fortimedix Surgical B.V. (Netherlands) features two channels for manually controlled flexible articulating surgical instruments. A third central channel accepts both rigid and flexible endoscopes. The system is coupled to a standard laryngoscope for transoral access. In three cadaver models, we evaluated the surgical capabilities using wristed grasping instruments, microlaryngeal scissors, monopolar cautery, and a laser fiber sheath. Procedures were performed within the oropharynx, supraglottis, glottis, subglottis, and hypopharynx. RESULTS Within the oropharynx, we found adequate strength, range of motion, and dexterity to perform lateral oropharyngectomy and tongue base resection. Within the larynx, visualization was achieved with a variety of instruments including a flexible, 0° and 30° rigid endoscope. The glottis, supraglottis, pyriform sinuses, post-cricoid space, and esophageal inlet were readily accessible. Visualization and manipulation of grasping, laser, and monopolar cautery instruments were also possible within the subglottis. Instrument reach and accuracy facilitated completion of a delicate micro-flap on the true vocal fold. Other procedures included vocal fold resection, cricopharyngeal myotomy, and resection of subglottic mucosa. CONCLUSIONS From this initial proof of concept experience with this novel platform, we found a wide range of procedures within the oropharynx, larynx, and hypopharynx to be feasible. Further work is needed to evaluate its applicability to the clinical setting. The ability of this platform to be used with conventional instrumentation may provide an opportunity for complex transoral surgery to be performed in a facile manner at greatly reduced cost.
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Karkos PD, Koskinas IS, Triaridis S, Constantinidis J. Lasers in Οtolaryngology: A Laser Odyssey From Carbon Dioxide to True Blue. EAR, NOSE & THROAT JOURNAL 2020; 100:1S-3S. [PMID: 32845805 DOI: 10.1177/0145561320951681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this special issue of the Ear Nose and Throat (ENT) journal entitled Lasers in Otolaryngology, we attempted to cover and accommodate different experiences from around the globe on both established and some not so well-known techniques and indications for Lasers in most ENT subspecialties. Despite the COVID 19 pandemic, authors from all over the world have expressed their interest in publishing their Laser experiences with ENT journal and for this we are very grateful.
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Affiliation(s)
- Petros D Karkos
- 1st Department of Otolaryngology-Head Neck Surgery, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis S Koskinas
- 1st Department of Otolaryngology-Head Neck Surgery, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Department of Otolaryngology-Head Neck Surgery, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Department of Otolaryngology-Head Neck Surgery, 37788AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Chiesa-Estomba CM, Suarez JAS, Ninchritz-Becerra E, Soriano-Reixach M, González-García JA, Larruscain E, Altuna X. Transoral Carbon Dioxide Microsurgery of the Larynx as a Day-Case Outpatient Procedure: An Observational, Retrospective, Single-Center Study. EAR, NOSE & THROAT JOURNAL 2020; 100:100S-104S. [PMID: 32804574 DOI: 10.1177/0145561320951049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Despite good results of transoral laser CO2 microsurgery (CO2TOLMS) of the larynx, a lack of data related to the safety of this technique as a day-case procedure across the literature is evident. MATERIALS AND METHODS An observational, retrospective, non-randomized study. RESULTS One hundred four (62.6%) patients met the inclusion criteria, 96 (92.3%) patients were male, and 8 (7.7%) patients were female. The mean age of the study group was 66 ± 11 years (min: 34/max: 90). All the patients underwent CO2TOLMS were treated as an outpatient procedure. The glottis was the most common location affecting 97 (93.3%) patients, regarding the need of readmission, just 4 (3.8%) patients needed to be readmitted after surgery due to dyspnea secondary to laryngeal edema in 2 cases by laryngeal bleeding, and cervical emphysema in one case, respectively. Being just necessary to reintubate 1 patient (<1%) to control the bleeding. We didn't find any statistical correlation between variables and the need for readmission of reintubation. CONCLUSION According to our results, CO2TOLMS of the larynx can be safely performed as an outpatient procedure. To establish a proper protocol and to perform a careful preoperative assessment are essential to increase our success rate and to prevent any potential complication.
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Affiliation(s)
- Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Jon A Sistiaga Suarez
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Elisabeth Ninchritz-Becerra
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Maria Soriano-Reixach
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Jose A González-García
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Ekhiñe Larruscain
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - Xabier Altuna
- Department of Otorhinolaryngology-Head and Neck Surgery, 16650Hospital Universitario Donostia, Donostia-San Sebastian, Spain
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Early Glottic Cancer Treated by Transoral Laser Surgery Using Toluidine Blue for the Definition of the Surgical Margins: A Pilot Study. ACTA ACUST UNITED AC 2020; 56:medicina56070334. [PMID: 32635245 PMCID: PMC7404472 DOI: 10.3390/medicina56070334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
Background and objectives: Transoral laser microsurgery (TLM) is widely accepted for its advantages, which consist of a brief hospital stay, rapid functional recovery, low management costs and the fact that it can be easily repeated in cases of recurrence. However, a high incidence of positive or narrow surgical margins has been reported in the literature, even if controversy still exists on the prognostic significance of positive resection margins. The aim of the study was to evaluate the utility of toluidine blue staining in defining the resection margins of early glottic cancer (T1a–T2) treated with TLM. Materials and Methods: This retrospective study was conducted on patients with early glottic cancer (T1a–T2) managed by TLM. A group of patients treated between 2010 and 2014 underwent toluidine blue staining (TB group) of the lesions before starting the cordectomy by TLM, and a group of patients treated by TLM between 2006 and 2009 was considered the control group. Results: A total of 44 subjects were included in this study: 41 were men, and 3 were women. The mean age was 58 ± 9.0 years (median 59.0, range 41–77). Twenty-three of the 44 patients were included in the TB group and 21 in the case control group. In the TB group, only the positivity of the deep margin was a predictor of local recurrence (p = 0.037), while in the control group, positive or close margins and the type of cordectomy were predictive factors of local recurrence (p = 0.049). Considering the TB group and control cases, the 5-year local recurrence-free survival was 95.6% and 80.9%, respectively (p = 0.14). Conclusions: From this first study, toluidine blue staining seems to be a useful modality to improve the rate of the negative resection margins of early glottic cancer (T1a–T2) treated by TLM.
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Lane C, Rabbani R, Linton J, Taylor SM, Viallet N. Systematic review and meta-analysis of transoral laser microsurgery in hypopharyngeal carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:66-73. [PMID: 32128432 PMCID: PMC7042655 DOI: 10.1002/lio2.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery has been suggested as an alternative treatment modality for hypopharyngeal carcinoma. The purpose of this study is to systematically review the oncologic and functional outcomes of patients with hypopharyngeal carcinoma when treated with primary transoral laser microsurgery. METHODS A comprehensive literature search was performed using PRISMA methodology on OVID MEDLINE and EMBASE. Meta-analysis was completed for oncological outcomes. RESULTS Six studies reported quality of life outcomes five reported oncologic outcomes. A median of 95% (range 0.83-0.98) patients achieving gastrostomy independence, a median of 3% (range 0%-6%) were tracheostomy dependent, and a median of 97% (Range 0.89-1.0) were able to preserve their larynx. Pooled five-year overall survival was 54% (CI, 0.50-0.58, I2 = 29%), pooled disease-specific survival was 72% (CI, 0.68-0.77, I2 = 46%), and pooled local control rate was 78% (CI, 0.72-0.85, I2 = 69%). CONCLUSION Systematic review supports improvements in functional outcomes and oncologic outcomes with transoral laser microsurgery.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Janice Linton
- Neil John Maclean Health SciencesUniversity of Manitoba LibrariesWinnipegManitobaCanada
| | - S. Mark Taylor
- Division of Otolaryngology‐Head and Neck SurgeryDalhousie UniversityHalifax Regional MunicipalityNova ScotiaCanada
| | - Norbert Viallet
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
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