Laryngeal biopsies are being performed more commonly as in-office procedure. ENT Today asked two otolaryngologists about the ins and outs of performing the procedure in-office.
Explore This IssueAugust 2009
Timothy Wallace, MD, Assistant Professor of Surgery at Dalhousie University in Halifax, Nova Scotia, spoke about the topic at Otolaryngology Update 2009 in Toronto. He has been performing in-office laryngeal biopsies for five years, and is a supporter of performing a variety of biopsies in this setting.
His first procedure was on a patient who presented with a vocal fold granuloma, but who had an intense fear of the operating room. With his office already situated in a hospital, it wasn’t difficult getting set up to do the procedure in his office.
Indications for In-Office Procedures
The indications he considers as eligible for doing in-office biopsies include retrieval of foreign bodies, the treatment or removal of benign lesions in patients who cannot tolerate general anesthesia or who aren’t good direct laryngoscopy candidates, and biopsy of suspicious lesions.
It is generally comfortable for patients and lacks the stress associated with OR procedures. It is also useful for older patients who have comorbidities or patients with anatomical considerations that preclude surgery. He finds patients need fewer days of voice rest.
When taking someone to the OR for microlaryngoscopy surgery, I have them voice rest for about a week. I ask them to whisper for five days, then gradually shift back to a normal voice. When you do in-office biopsy for small lesions, patients are basically back with a full voice in less than a week, he said.
In-office laryngeal biopsies are also beneficial to patients who require a high number of laryngeal procedures. Less surgery equals less trauma, he said.
There is also the added benefit of doing a procedure in about five minutes that would normally take more than a hour of OR time. Not only is it faster, but the reduced OR time also represents a savings to the health care system.
Which Procedures Can Be Done In-Office?
Many otolarynglogists do angiolytic surgery as an in-office procedure, but Dr. Wallace prefers not to. However, Michael M. Johns III, MD, Assistant Professor of Otolaryngology at Emory University in Atlanta, told ENT Today that he does includes angiolytic surgery on his list of in-office procedures.
I use photoangiolytic therapy using a pulsed KTP laser, he said. However, he had a few tips for general otolaryngologists considering doing this. Spend time observing someone with experience doing the procedure. It is not hard, but it is filled with nuance, which makes the difference between good outcomes and bad ones.