Laser Microsurgery for Glottic Cancer

Abstract

Carbon dioxide (CO₂) transoral laser microsurgery (TLM) under direct laryngoscopy is the most widely used surgical modality for laryngeal neoplasms treatment.

By TLM the entire lesion is removed in an en-bloc modality, obtaining wide endoscopical surgical margins. It sounds good for oncological control and voice preservation, by enabling the surgeon to a tailored resection of the vocal cord.

Under general anesthesia, after oro-tracheal intubation with a specific double-cuffed endotracheal tube (Laser-Flex Mallinckrodt, Athlone, Ireland, or Laser Shield II, Xomed, Jacksonville, Florida), the larynx is exposed and suspension is obtained. A bedside assistant exercises external counterpressure of the larynx in order to expose the anterior commissure region.

Before starting TLM, it is mandatory to intraoperatively explore the larynx with angle rigid endoscopes (we suggest 30° and 70°), examining both vocal cords, ventricles, and subglottis. The surgeon might use an endoscopic rigid pinch to assess the consistency of the tumor at the level of its margins, raising the false vocal fold to evaluate tumor’s extension into the ventricle.