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

by Mary Beth Nierengarten •

For Dr. Shapshay, improving the use of lasers to treat conditions that include the airway has been a particular concern for quite some time.

For many years, the ‘holy grail’ for those of us using the CO2 laser in the airway has been the development of a suitable fiber to allow CO2 laser transmission in the airway, he said. Up to this point, we have been limited by the lack of a fiber able to transmit this wavelength-particularly in the tracheobronchial area.

Recent development of a photonic bandgap fiber assembly, developed by the OmniGuide Company in Cambridge, MA (www.omni-guide.com ), has led to the development of a novel way to deliver the CO2 laser through a flexible endoscope. Different names are used to describe this assembly, including the CO2 waveguide and the flexible fiberoptic CO2 laser.

Two studies recently presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting reported promising results with this new delivery approach. One study, coauthored by Dr. Shapshay, retrospectively analyzed the medical records of 14 patients treated with the CO2 waveguide or pulsed dye laser for lesions in the upper aerodigestive tract (UADT). Most patients were treated for papilloma (n = 8); of these, two patients recurred two months after surgery and two patients had stable papillomas at five months. No perioperative complications were noted, including respiratory distress, dysphonia, or dysphagia.

According to Dr. Shapshay, who is on the Scientific Advisory Board of the Omniguide Company and a paid consultant, this was the first time we were able to deliver the CO2 laser efficiently and safely using a flexible fiber through a flexible fiberoptic laryngoscope.

Further refinements to this laser are currently under development by OnmiGuide, he said. The CO2 laser waveguide needs to be refined for laryngeal applications in the office for benign lesions such as polyps and nodules, he said. In the near future there will be a smaller-diameter fiber with a 250-micron spot size with a suitable aiming light providing higher power density and greater precision.

In another study presented at the AAO-HNS conference, Dr. Holsinger and his colleagues from M. D. Anderson Cancer Center retrospectively analyzed a number of patients treated for a variety of conditions using the newer fiberoptic delivery system. The study found that the flexible fiberoptic CO2 laser had advantages over the older CO2 system for situations with difficult laryngeal exposure, in conservation laryngeal surgery, and for diagnostic biopsy.