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Laser-Assisted Surgery of the Upper Aero-Digestive Tract

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Laser-Assisted Surgery of the Upper Aero-Digestive Tract Eur Arch Otorhinolaryngol (2017) 274:3723–3727 DOI 10.1007/s00405-017-4708-3 LARYNGOLOGY Laser‑assisted surgery of the upper aero‑digestive tract: a clarifcation of nomenclature. A consensus statement of the European Laryngological Society Marc Remacle9 · Christoph Arens1 · Mostafa Badr Eldin2 · Guillermo Campos3 · Carlos Chiesa Estomba4 · Pavel Dulguerov6 · Ivana Fiz7 · Anastasios Hantzakos8 · Jerôme Keghian9 · Francesco Mora11 · Nayla Matar10 · Giorgio Peretti11 · Cesare Piazza12 · Gregory N. Postma13 · Vyas Prasad14 · Elisabeth Sjogren15 · Frederik G. Dikkers5 Received: 5 June 2017 / Accepted: 8 August 2017 / Published online: 17 August 2017 © Springer-Verlag GmbH Germany 2017 Abstract Acronyms and abbreviations are frequently used ­CO2 TOLMS or CO­ 2 laser transoral surgery only (with a in otorhinolaryngology and other medical specialties. ­CO2 handpiece) would be defned as ­CO2 TOLS. KTP transnasal laser-assisted transoral surgery of the pharynx, the larynx fexible laser surgery would be KTP TNFLS. Transoral use and the upper airway is a family of commonly performed of the fexible ­CO2 wave-guide with a handpiece would be a surgical procedures termed transoral laser microsurgery ­CO2 TOFLS. One can argue that these clarifcations are not (TLM). The abbreviation TLM can be confusing because of necessary and that the abbreviation TLM for transoral laser alternative modes of delivery. Classifcation and defnition microsurgery is more than sufcient. But this is not the case. of the diferent types of procedures, performed transorally Laser surgery, ofce-based laser surgery and microsurgery or transnasally, are proposed by the Working Committee are frequently and erroneously interchanged for one another. for Nomenclature of the European Laryngological Society, These classifcations allow for a clear understanding of what emphasizing the type of laser used and the way this laser was performed and what the results meant. is transmitted. What is usually called TLM, would more clearly be defned as ­CO2 laser transoral microsurgery or 9 * Marc Remacle Department of Otorhinolaryngology Head and Neck [email protected] Surgery, CHL-Eich, Rue d’Eich 78, Luxemburg, Luxemburg 10 1 Faculty of Medicine, Hotel Dieu de France Hospital, Saint Department of Otorhinolaryngology, University Hospitals Joseph University, Beirut, Lebanon Magdeburg, Otto-von-Guericke University, Magdeburg, 11 Germany Department of Otorhinolaryngology Head and Neck Surgery, University of Genoa, Genoa, Italy 2 Department ENT‑HNS, Ain-Shams University, Cairo, Egypt 12 3 Department of Otorhinolaryngology, Head and Neck Department of Surgery, Fundación Santa Fe Hospital Surgery, University of Brescia, Brescia, Italy Universitario, Instituto de Laringología, Universidad de la 13 Sabana School of Medicine, Bogotá, DC, Colombia Department of Otolaryngology, Center for Voice, Airway 4 and Swallowing Disorders, Medical College of Georgia ENT‑Head and Neck Department, Hospital Universitario at Augusta University, Augusta, GA, USA Donostia, San Sebastián, Spain 14 5 Department of Otolaryngology Head and Neck Surgery, Department of Otorhinolaryngology, Head and Neck National University Health System, Ng Teng Fong General Surgery, Academic Medical Center, University Hospital, Singapore, Singapore of Amsterdam, Amsterdam, The Netherlands 15 6 Department of ENT, Head and Neck Surgery, Leiden Department of Otorhinolaryngology, Head and Neck University Medical Center, Leiden, The Netherlands Surgery, Geneva University Hospital, Geneva, Switzerland 7 Department of Otorhinolaryngology, Head and Neck Surgery, Katharinenhospital, Stuttgart, Germany 8 Department of Otolaryngology, Head and Neck Surgery, Surgical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates Vol.:(0123456789)1 3 3724 Eur Arch Otorhinolaryngol (2017) 274:3723–3727 Keywords Laser-assisted surgery · Transoral laser Approach microsurgery (TLM) · Nomenclature · TOLMS · TOLS · TNFLS · TOFLS The approach can be either transnasal (TN) or transoral (TO). In rare specifc cases a diferent approach might be possible, but it seems unnecessary to include these rare approaches in a general classifcation scheme. Introduction The laser in use Acronyms and abbreviations are frequently used in oto- rhinolaryngology and other medical specialties: PTSD for The most frequently used laser in otolaryngology is the post-traumatic stress disorder, FNA for fne needle aspira- CO2 (carbon dioxide) laser. Other lasers used are the KTP tion, FESS for functional endoscopic sinus surgery, and (potassium titanyl phosphate), TH (thulium), LD (laser FEES for fexible endoscopic evaluation of swallowing, diode), PDL (pulsed dye laser), or Nd:YAG laser (Neo- and fnally LASER itself means light amplifcation by dymium Yttrium Aluminum Garnet), just to name a few. In stimulated emission of radiation. a classifcation system, there should be no doubt as to what CO2 laser-assisted transoral surgery of the pharynx, the kind of laser has been used. Therefore, the most frequently larynx and the upper airway is a family of commonly per- used acronym in the literature should be applied in each formed surgical procedures termed transoral laser micro- case or otherwise clearly specifed. surgery (TLM) [1]. TLM was initially intended, for the treatment of early laryngeal and pharyngeal cancers, using The way the laser beam is transmitted the CO2 laser straight beam in combination with a surgi- cal microscope. Recent advances and refnements of laser The laser can be transmitted to the target using diferent tools and surgical techniques now make it possible to use optical devices. Two surgical modalities are most fre- lasers, delivered through diferent methods, for advanced quently used. The frst is microsurgery in which a straight carcinomas, microendoscopic laryngotracheal reconstruc- laser beam is directed via a microscope through a micro- tion, treatment of recurrent respiratory papillomas and manipulator. The second modality is performing fexible phonomicrosurgery. The abbreviation TLM can be confus- laser surgery, using fexible fbers to deliver lasers like ing because of alternative modes of delivery. Wave-guides KTP or the CO 2 wave-guide. A third modality, using a made of a pliable hollow glass-tube covered inside with a rigid CO2 laser handpiece with either a straight beam or metallic alloy have been designed to be used to direct the refecting handpiece can be employed for surgery under CO2 laser beam transorally with a handpiece or transna- direct illumination and vision or with rigid endoscopic sally through fexible endoscopes [2]. Also, fber-guided assistance (e.g., laser ablation of tonsils). lasers like KTP (potassium titanyl phosphate) or thulium In this manner, what is usually called TLM, would more can also be used transnasally through the operative chan- clearly be defned as CO2 laser transoral microsurgery nel of a video endoscope [3–5]. or CO2 TOLMS (Fig. 1) or CO2 laser transoral surgery The authors, members of the Working Committee for Nomenclature of the European Laryngological Society (ELS), propose a classifcation and defnition of the dif- ferent types of procedures, performed transorally or trans- nasally, emphasizing the type of laser used and the way this laser is transmitted. Only the pharynx and larynx are concerned in this ELS classifcation and not the ear. Materials and methods Our proposition is to defne three separate domains for laser-assisted surgery of the larynx and pharynx: the approach, the laser in use and the way the laser beam is transmitted. Fig. 1 CO2 Transoral laser microsurgery or CO2 TOLMS 1 3 Eur Arch Otorhinolaryngol (2017) 274:3723–3727 3725 only (with a handpiece) would be defned as CO2 TOLS (Fig. 2). KTP transnasal fexible laser surgery would be KTP TNFLS (Fig. 3). Transoral use of the fexible CO 2 wave-guide with a handpiece would be a CO2 TOFLS (Fig. 4a, b). In the case of CO2 TOLFS, what is impor- tant to consider is the fact that the CO 2 fber is used tran- sorally that can be under microscope or rigid telescope visualisation. Table 1 summarizes how the proposed classifcation sys- tem works. Discussion Fig. 2 CO2 Transoral laser surgery or CO2 TOLS One can argue that these clarifcations are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufcient. But this is not the case. Without a clear defnition the M of TLM is refereing the use of a microscope. But as other approaches are more and more used, a classifcation as clear as possible is necessary. Laser surgery, office-based laser surgery and microsur- gery are frequently and erroneously interchanged for one another during presentations and even in some articles [6, 7], with people confusing the tool, the approach, and the setting. Lasers of various wavelengths are a different way to interact with tissues during a surgical procedure, just as with cold steel instruments, and the approach might be endoscopic, transnasal or transoral. If all the parameters, settings and tools are not clearly specified, unintended confusion may result in difficulty reproducing results from a given institution. More importantly, it could lead to adverse clinical outcomes for a patient being treated Fig. 3 CO2 Transnasal fexible laser surgery or CO2 TNFLS by less experienced surgeons. The indications, expected Fig. 4 CO2 Transoral fexible laser surgery or CO2 TOFLS. a With microscope. b With rigid telescope 1 3 3726 Eur Arch Otorhinolaryngol (2017) 274:3723–3727 Table 1 Some domains and modalities and abbreviations
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