Carbon Dioxide Laser Scores Well on Patient Tolerance in the Office

Advantages of Office-Based Surgery

Laryngeal surgery performed right in the office is better in many ways than more involved procedures that require general anesthesia. According to Dr. Moberly, Office-based laryngeal surgery has multiple advantages over traditional laser surgery performed in the operating room. These include decreased cost, recovery time, and discomfort, as well as increased patient safety and satisfaction.

Recurrent glottal dysplasia and recurrent respiratory papillomatosis are among the benign disorders suited to office treatment. Most of these benign diseases require multiple surgical treatments, Dr. Moberly said. Office-based surgery offers the option of treating more frequently and at an earlier disease stage.

The CO2 laser uses a photonic band-gap fiber assembly with a dielectric mirror and supportive cladding surrounding a hollow center that delivers the laser beam and nitrogen gas. A water-targeting laser such as the CO2 laser is better in some ways than the photoangiolytic pulsed-dye laser, which is limited by its depth of penetration and therefore is not particularly suited for diseases with a large amount of bulky disease.

Dr. Moberly added that with the pulsed-dye laser, you can see a mild blanching appearance, but the office use of the pulsed-dye laser is limited by an inability to determine how much of the bulky disease is being treated. With the CO2 laser, on the other hand, you can see obvious physical debulking of the diseased tissue.

He recommended that further research explore other subtleties of office-based treatment using the different laser types. Future studies would be beneficial to compare differing laser power settings as well as patient outcomes.

Comments on the Study

Clark Rosen, MD, Associate Professor of Otolaryngology at the University of Pittsburgh and Director of the University of Pittsburgh Voice Center, called it an important study.

There’s been a recent move afoot to perform some of these procedures in the office under local anesthesia, which is a huge advantage, Dr. Rosen said. This study very nicely demonstrated that the procedure was very well tolerated.

But he said there might not be a sudden spike in office-based procedures because of an insurance snag.

The technology has moved faster than the insurance companies have recognized, Dr. Rosen said. It’s still not something that’s probably appropriately reimbursed.

©2009 The Triological Society