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Avoiding the Operating Room: The Advantages of Office-Based Laryngology and Esophagology

by John Austin •

Another limitation of the PDL, according to Dr. Zeitels, is the 0.6 mm fiber, which he said cannot be reduced. The fiber can cut up the channel of the scope and we were getting frequent repairs. That is a problem, he said. The solid-state laser in the KTP is much more reliable; we’ve never had a breakdown with it. Also, the length and width of the KTP is about the same, but it was 16 inches deep as opposed to 38 inches deep, so the footprint it takes up in your clinic is less.

A big advantage of the KTP is the ability to use different sized fibers-0.2 mm to 0.6 mm-which is critical to being able to suction effectively during the procedure.

You want a small fiber so you can control all of the secretions and whatever blood may happen, he said. But there’s almost no bleeding with the KTP, you don’t need to calibrate, and the pulse width is variable. It’s a lovely instrument to use.

Dr. Zeitels believes the new thulium laser, which was originally developed in Germany to cut brain tissue, also holds great promise.

The thulium simulates the function of a CO2 laser but gets delivered on a fiber, he said. They’ve already used it to cut kidneys and have done partial nephrectomies without cross-clamping the renal artery. Basically, anything that’s ablative, you can do with the thulium.

I have really started to do a lot more diagnostic testing with the injection procedure. Instead of just taking them to the operating room, I may inject them with a temporary substance and just see if their symptoms improve. – -Milan Amin, MD

Transnasal Esophagoscopy

Gregory Postma, MD, Professor of Otolaryngology and Director of the MCG Center for Voice and Swallowing Disorders at the Medical College of Georgia in Augusta, is a big fan of transnasal esophagoscopy (TNE), noting that physicians are still discovering new indications for this versatile and reliable technology.

With TNE, we can biopsy virtually anything, anywhere, he said. We’ve biopsied lesions of the nasopharynx with this, and gone as far down as the right upper lobe bronchus under topical anesthesia. We have taken literally thousands of biopsies and have yet to have a single complication.

TNE can also be used to evaluate foreign bodies, he noted, but I don’t advocate their removal, although if they’re distal, we’ve had great success at pushing these into the stomach.