Carbon dioxide laser fiber for laryngeal cancer surgery.
OBJECTIVE
The carbon dioxide laser has evolved to be the premier dissecting instrument for hemostatic cutting during endolaryngeal cancer resection. However, dissection is limited to mirror-reflected line-of-sight delivery of the laser. A recently developed flexible, hollow photonic bandgap fiber (PBF) appears to offer advantages in endolaryngeal dissection.


METHODS
The suitability of the PBF for human application was evaluated in a canine experiment in which human surgical procedures for microlaryngoscopic en bloc partial laryngectomy were simulated. The specimens that were resected endoscopically and the completion laryngectomy specimen were evaluated histologically.


RESULTS
Observations from this experiment revealed that en bloc partial laryngectomy procedures were substantially easier to achieve as compared with prior experience in humans. This improvement resulted from three factors: 1) enhanced tangential dissection due to increased angulation of the laser energy, 2) enhanced procedural orientation due to proprioception of the tissues in contact mode, and 3) improved hemostasis. Histopathologic analysis of the resection margins revealed minimal thermal trauma.


CONCLUSIONS
The PBF shows substantial promise for human application in endoscopic partial laryngectomy. It will likely enhance the ability of any surgeon to extend his or her indications for performing endoscopic laryngeal cancer resections regardless of philosophy (en bloc resection or piecemeal).
Zeitels
Steven M
SM
Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, MA 02114, USA.
Kobler
James B
JB
Heaton
James T
JT
Faquin
William
W
D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004867:Equipment Design; D005336:Fiber Optic Technology; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007828:Laryngoscopy; D053685:Laser Therapy / Q000295:instrumentation*