Office-based and microlaryngeal applications of a fiber-based thulium laser

Objectives: The carbon dioxide (CO2) laser is the premier dissecting instrument for hemostatic cutting and ablation during endolaryngeal surgery. However, microlaryngeal tangential dissection and office-based photoablation have been limited by the lack of a fiber-based delivery system. To address this limitation, a new laser was designed, which is a diode-pumped solid-state laser with a thulium-doped yttrium-aluminum-garnet laser rod. It produces a continuous-wave beam with a wavelength of 2,013 nm and a target chromophore of water. This new laser functions similarly to a CO2 laser with the benefit of being delivered through a small glass fiber (0.365 to 0.550 mm). Methods: A prospective pilot trial was done in 74 cases to explore applications of the new thulium laser. Thirty-two procedures were done with the laser used as an ablating instrument and topical anesthesia through a flexible laryngoscope (papillomatosis, 20; microinvasive carcinoma, 6; benign supraglottic lesions, 3; edema, 2; granuloma, 1). Forty-two procedures were done with the laser used as a cutting or ablating instrument for microlaryngeal dissection and general anesthesia. These included 27 partial laryngeal resections (supraglottis, 15; glottis, 10; subglottis, 2) and 8 posterior glottic laryngoplasties. The laser was also used as an ablative instrument during microlaryngoscopy in 7 cases. Results: The thulium laser was used effectively in all cases, under both local and general anesthesia. In microlaryngeal dissection, electrocautery was not needed to control bleeding, even during cutting in the highly vascular paraglottic space. No complications related to the use of the thulium laser were experienced in any case. Conclusions: Because of the fiber-based delivery system, the 2,013-nm continuous-wave thulium laser shows substantial promise for tangential dissection during microlaryngoscopy and soft tissue photoablation during office-based flexible laryngoscopy. Hemostasis was judged to be superior to experiences with the CO2 laser. In this pilot study, performing en bloc laryngeal cancer resection procedures was facilitated by use of the thulium laser.