Building on our pioneering development, since 1983, of office-based surgery on the laryngopharynx, Bastian Voice Institute has added two new lasers to its videoendoscopy procedure room capabilities.
Eighteen months ago, we obtained the thulium laser. Tissue effects are similar to those of the CO2 laser—except that laser energy is delivered via a glass fiber, passed through the channel of a flexible video-endoscope. We use the thulium laser primarily in the treatment of papillomas, granulomas that need a “stalk” divided, and clearly benign leukoplakia.
Recently, we have acquired the pulsed-KTP laser, also for office-based surgery. Laser energy is likewise delivered via a glass fiber, but the chromophore is not the water molecule, but instead the hemoglobin molecule, which makes this laser well-suited to treating vascular lesions, including capillary ectasia, lower-bulk papillomas, sessile granulomata, and pre-cancerous lesions or early, superficial carcinomas.
“Office-based” surgery is not appropriate for all lesions: e.g. those seen in singers with otherwise-irreversible lesions, or for cysts and glottic sulci or when large cancers are to be removed via laser excision. When appropriate, however, an advantage of videoendoscopy procedure room laser surgery is that patients can drive themselves to and from the procedure, saving both time and expense. In addition, certain tracheal lesions are more easily accessed through this approach, and persons with anatomical or medical issues that prohibit general anesthesia may be more safely and effectively managed.
While we continue to use time-honored operating room methodologies, this newer “awake patient” laser methodology is adding yet another option to BVI’s treatments of voice, swallowing, and airway disorders.