More than Smoke and Mirrors: Expanding Technology and Use of Lasers in Otolaryngology-Head and Neck Surgery

According to Dr. Belafsky, the laser may also be ideal for frequently performed procedures such as tonsillectomy and adenoidectomy, palate surgery, endoscopic sinus surgery, and turbinate reduction. Because of the precise delivery and limited depth of penetration, preliminary experience suggests that post-tonsillectomy pain may be less with the Lightforce laser, he said. Evidence of this comes from a prospective study he and his colleagues presented at the AAO-HNS meeting, which showed that children treated for tonsillectomy by the 980 nm laser required significantly less postoperative pain medication than those treated with coblation and were able to discontinue narcotic use more quickly than the coblation-treated patients.

Using Lasers in Office-Based Settings

Increasing attention is being focused on using lasers in office-based settings, particularly with the advent of systems that don’t require anesthesia. For Dr. Woo, the demand for the new flexible laser devices and other emerging technology such as the PDL is largely being driven by patients. I think that a large impetus driving this is that the patient does not have to undergo anesthesia, he said, adding that we still don’t know if this new technology will actually benefit patients, say, in terms of saving them money.

For Dr. Belafsky, however, saving money may be one of the advantages of this new technology. Office-based laryngeal surgery has the ability to save the health care system millions of dollars by keeping patients out of the operating room, he said.

One area that may need particular attention as these new flexible devices become more widely used is the need to properly educate clinicians on their clinical application and safety. According to Dr. Woo, training in the original CO2 laser is included in the residency education of otolaryngology residents and includes three levels of training as outlined in the bylaws of the American Society for Laser Medicine and Surgery (ASLMS). These include a didactic portion of the basic science of lasers, a hands-on portion in which residents use the laser in, for example, soft tissue or animals, and a preceptorship in which the resident works with a trained physician to perform laser procedures. A description of procedural skills for using lasers in general surgery can be found on the ASLMS Web site at www.aslms.org/public/standardpsgs.shtml .

For the newer technologies such as the pulsed dye lasers, however, there is little to no regulation on their purchase or use, said Dr. Woo. It is really remarkable that there are no specific federal guidelines, he said, adding that clinicians are often trained in these lasers only through the sales representatives who sell them.