Watch Surgeons Demonstrate How Lumenis CO2 Technology is Changing Delicate Transoral Procedures
Lumenis’s virtual webinar highlights the effectiveness of CO2 laser technology in head & neck surgeries.
June 24, 2020 – Yokneam, Israel
Lumenis recently hosted a virtual webinar about practice patterns and techniques in using CO2 laser technology in laryngology and head & neck surgery. During the webinar, three leading surgeons currently using Lumenis CO2 lasers, fibers and accessories shared case videos, as well as their techniques and thoughts about the future direction of transoral laser microsurgery (TLM) in their fields. The webinar is now available online. Here is a preview of the presentations:
The CO2 laser’s effects are tailored for efficacy and protection of delicate tissues
– C. Gaelyn Garrett, MD, MMHC, Senior Executive Medical Director at Vanderbilt Voice Center in Nashville, showed through three different cases how the UltraPulse DUO CO2 laser with the Digital AcuBlade (DAB) Robotic Scanning Micromanipulator can be used with different settings and techniques to achieve a range of desired effects, all while protecting the underlying vocal fold structures, such as the lamina propria. In her first case, Dr. Garrett efficiently treats bilateral vocal fold paralysis, creating a full-thickness, deeply lateralized cordotomy incision while maintaining hemostasis. Next, with different settings to optimize clean cutting, she excises laryngeal papilloma at the base with a 1.2mm DAB line, minimizing thermal damage to healthy tissue and sealing blood vessels. Finally, Dr. Garrett gently coagulates a vocal fold vascular ectasia for a professional singer, improving his pitch control, by using a low-powered (1W) continuous wave single de-focused spot in repeat pulse mode. These case videos pronounce the diversity of tissue effects that can be achieved with one instrument.
CO2 lasers are changing the standard of care for laryngeal cancer
Chris Holsinger, MD, FACS, Professor and Chief of Head & Neck Surgery at Stanford University, Palo Alto, advocates for the true multidisciplinary evaluation and treatment of patients with laryngeal cancer. For years, due to limitations of traditional “open” procedures, surgery was relegated to a second-tier option. However, in modern data tumor boards, when considering surgery vs. radiation, transoral endoscopic head and neck surgery may be an ideal option. Full-dose radiation therapy lasting 6-7 weeks may sometimes not be necessary, especially when considering the functional impact from late toxicity. Conforming with his ethos of conservative surgery, instead of relegating TLM to only salvage surgery, he performs precise CO2 laser excision of early-to-intermediate stages of malignant tumors, especially in applications such as supraglottic laryngectomy where the role transoral robotic surgery can be limited. Using the DAB, Dr. Holsinger controls depth, diameter and energy to achieve the narrow but definitive margin needed to precisely remove the tumor while limiting thermal damage to 15 microns.1 Survival outcomes are excellent and due to soft-tissue remodeling and rehabilitation, patients’ anatomy and function are restored.
Current CO2 laser technology is compatible with robotic and microscope-free approaches
J. Scott Magnuson, MD, FACS, Professor of Otolaryngology and Head & Neck Surgery, Advent Health Cancer Institute, Orlando, used two case studies to illustrate how Lumenis CO2 DUO lasers are changing head & neck surgery. First, Dr. Magnuson demonstrated how the DAB can be used with the #VITOM3D exoscope (Karl #Storz). Surgery is clear and efficient with the combination of 3D goggles, while instrument (VITOM3D and DAB) controls are shared with an assistant. Dr. Magnuson also discussed the FiberLase with Robotic Drop-in Guide, Lumenis’s flexible CO2 laser platform, which enables robotic control of the laser. This approach was attempted with a thulium laser, then discontinued due to lack of a true differentiation in tissue effect from monopolar electrocautery, which is standard on the robot. With FiberLase comes the potential for marrying the best of both worlds: the precision CO2 and the 3D visualization with wristed action of the robot. Later in the Q&A, it was highlighted that the #Flex Laser Holder (#Medrobotics) allows seamless integration of the FiberLase waveguide, enabling 3-handed surgery and the ultrafine soft tissue handling of CO2 lasers. When working just millimeters away from arytenoid, voice outcomes can easily be preserved with CO2 lasers, while other surgeries would place much more emphasis on slow, deliberate dissections.