How To: Novel Use of Ultrasonic Aspirator Device for Cricoid

by Neel K. Bhatt, MD, William Z. Gao, MD, Lindsay S. Reder, MD, and Karla O’Dell, MD •

The patients were positioned in a supine fashion and general anesthesia was induced. Jet ventilation through a Storz Dedo operating laryngoscope was used in patient 1, while patient 2 was intubated transorally using a laser-safe endotracheal tube. A suspension microlaryngoscopy surgical approach was used. In patient 2, the overlying mucosa was incised using a carbon dioxide (CO2) laser. The UA blade cost was approximately $500 (Sonopet, Stryker Corp, Model #5450 820 302). The extended-length angled handpiece and console (Sonopet, Stryker Corp, Model #:5450 820 000) costs were $15,000 and $85,000, respectively. This equipment had been routinely used by other specialties, including neurosurgery. Thus, these highlighted cases did not require special equipment purchasing.

The device was introduced through the lumen of the laryngoscope and the chondroma was resected. Resection setting was as follows: power at 100%, suction at 100%, and irrigation at 15 ml/min. In both cases, the majority of chondroma resection was performed by a single surgeon holding the UA in one hand and a 0-degree telescope in the other. The operating microscope was used intermittently when a bimanual technique was needed (e.g., laser cuts, suturing). A specimen was sent for pathology. The entirety of the visible mass was resected, and no cases required conversion to an open approach. Following resection, the overlying mucosa was reapproximated using a transoral suturing technique in patient 2. Patient 1 required no mucosal sutures given the minimal degree of mucosal violation. Both patients were discharged on postoperative day one. The key steps from Patient 1’s surgery are included in video format (see supporting video).

RESULTS

Postoperatively, there were no adverse events, and patients resumed an oral diet. Both patients reported subjective improvement in voice and swallowing complaints.