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Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO2 laser

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Despite causing significant thermocoagulative insult, use of the carbon dioxide (CO2) laser is considered gold standard in surgery for early stage larynx carcinoma. Limited attention has been paid to the use of the erbium:yttrium–aluminium-garnet (Er:YAG) laser in laryngeal surgery as a means to reduce thermal tissue injury. The objective of this study is to compare the extent of thermal injury and precision of vocal fold incisions made using microsecond Er:YAG and superpulsed CO2 lasers. In the optics laboratory ex vivo porcine vocal folds were incised using Er:YAG and CO2 lasers. Lateral epithelial and subepithelial thermal damage zones and cutting gap widths were histologically determined. Environmental scanning electron microscopy (ESEM) images were examined for signs of carbonization. Temperature rise during Er:YAG laser incisions was determined using infrared thermography (IRT). In comparison to the CO2 laser, Er:YAG laser incisions showed significantly decreased epithelial (236.44 μm) and subepithelial (72.91 μm) damage zones (p < 0.001). Cutting gaps were significantly narrower for CO2 (878.72 μm) compared to Er:YAG (1090.78 μm; p = 0.027) laser. ESEM revealed intact collagen fibres along Er:YAG laser cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 laser incisions. IRT demonstrated absolute temperature rise below 70 °C for Er:YAG laser incisions. This study has demonstrated significantly reduced lateral thermal damage zones with wider basal cutting gaps for vocal fold incisions made using Er:YAG laser in comparison to those made using CO2 laser.

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Conflict of interest

R. Knecht is a member of the Advisory Boards of Merck Serono, Sanofi Aventis, Boehringer Ingelheim and Bayer Healthcare, Leverkusen.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Arne Böttcher, Nathan Jowett, Stanislav Kucher, Rainald Knecht, Wolfgang Wöllmer, Adrian Münscher & Carsten V. Dalchow

  2. Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada

    Nathan Jowett

  3. Leibniz Institute for Experimental Virology, Heinrich Pette Institute, University of Hamburg, Hamburg, Germany

    Rudolph Reimer

  4. Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Udo Schumacher

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  1. Arne Böttcher
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  2. Nathan Jowett
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  3. Stanislav Kucher
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  4. Rudolph Reimer
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  5. Udo Schumacher
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  6. Rainald Knecht
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  7. Wolfgang Wöllmer
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  8. Adrian Münscher
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  9. Carsten V. Dalchow
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Correspondence to Arne Böttcher.

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A. Böttcher and N. Jowett contributed equally to this work and share the first authorship.

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Böttcher, A., Jowett, N., Kucher, S. et al. Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO2 laser. Eur Arch Otorhinolaryngol 271, 1121–1128 (2014). https://doi.org/10.1007/s00405-013-2761-0

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  • DOI: https://doi.org/10.1007/s00405-013-2761-0

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