The use of laser in Ear/Nose/Throat surgery: is there any evidence?

Description

Surgical lasers have been used in ear, nose, and throat (ENT) surgery for several decades. The main advantages of the use of surgical lasers are:
1. Rigid and flexible endoscopic application of a high-energy incisional/ablative source in very small spaces
2. Precise incision in tissues while diffuse hemorrhage is controlled
3. Minimal thermal damage spread if correct technique is used
4. Vaporization of small lesions
5. Precise excision in muscular tissue (tongue) without diffuse bleeding and muscle contraction
In humans, CO2 laser is a standard tool for several ENT procedures, including vocal cord lesions and laryngeal tumors. In companion animals, limited data exists on the use of diode laser for partial arytenoidectomy,1 excision of tongue lesions,2,3 laryngeal4 and tracheal tumors,5,6 and deroofing of nasopharyngeal sialoceles via retroflexed flexible endoscopy,7 showing feasibility and efficacy of laser surgery in these locations (Figure 1). There is increasing evidence of the efficacy of laser surgery in treatment of more often encountered pathology, such as brachycephalic obstructive upper airway syndrome. CO2 laser staphylectomy is comparable in effectiveness and complications to standard incisional technique.8–10 However, it is faster, bloodless, and suturing is not necessary. Furthermore, laser facilitated the development of an additional procedure to reduce nasal airway resistance: Laser assisted turbinectomy.11–14
In the present lecture, a short overview will be given on laser types and procedures in veterinary ENT laser surgery, as well as examples of clinical cases. Furthermore, results of a novel rhinoscopic laser tumor debulking procedure in combination with radiation therapy in dogs will be presented.
We prospectively evaluated feasibility, effectiveness, complications, and long-term follow-up of minimally invasive rhinoscopic laser ablation of residual intranasal tumor mass after previous curative intent external beam megavoltage radiation therapy in dogs. Dogs with residual/recurrent intranasal tumor on follow-up CT evaluation 3 months after radiation therapy were offered surgical reduction/removal of the mass by laser ablation (1064 nm Nd:YAG or 1470 nm diode) through a normograde or retrograde rhinoscopy approach. Additional follow up diagnostic imaging and/or rhinoscopy, and repeated laser surgery if indicated, were performed at the courtesy of the owner. Fifteen dogs received a median of 2 (range 1-6) laser treatments on an outpatient basis. Median survival time was 661 days. Clinical signs post laser ablation were considered mild and included temporary mucoid discharge, mild epistaxis, and sneezing. Repeated treatment sessions did not increase the risk for side effects. It is concluded that rhinoscopic laser ablation of residual intranasal neoplasia following radiation therapy is a feasible and repeatable adjunctive therapy providing long-term mass reduction and improved quality of life.

Period	5 Jul 2019
Event title	European College of Veterinary Surgeons: Annual Scientific Meeting 2019
Event type	Conference
Conference number	28
Location	Budapest, HungaryShow on map
Degree of Recognition	International