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

Recent evidence on the efficacy of the PDL was presented at the AAO-HNS conference by Dr. Belafsky and colleagues. In a retrospective analysis of 32 patients who underwent 88 PDL treatments for recurrent respiratory papillomatosis (n = 16), Reinke’s edema (n = 5), vocal fold leukoplakia (n = 3), granuloma (n = 3), polyp (n = 3), varix (n = 1), and vallecular cyst (n = 1), ablation of all visible disease was achieved for the majority of the procedures performed (85%). Early termination of a procedure occurred in 15% of the procedures, largely because a comfortable level of anesthesia was not achieved. Of the 32 patients, 7 (22%) received general anesthesia at least once during their treatment. Overall, the authors concluded that papillomas are easily and safely treated but remain highly recurrent. Reinke’s edema and vocal fold polyps respond very well to the effects of the laser but may require multiple treatments.

[The PDL] is very amenable to use in an unsedated patient through a flexible laryngoscope in the office setting, said Dr. Belafsky. If the patient swallows or coughs during the procedure and the vocal folds move, the laser is unlikely to cause any harm. With a more destructive laser, he added, if the patient coughs or swallows, severe damage could result.

According to Dr. Belafsky, the PDL is currently is still rare in the community but is becoming more widespread among academic centers.

Until more data is available on this technology, however, Dr. Woo feels that the PDL should properly be classified as an emerging technology that needs to undergo proper assessments before it can be considered as standard of care. At this point, he said, the data support it only for consideration as an alternative treatment.

On the horizon for more widespread use may be another emerging cutting-edge laser that Dr. Belafsky and his colleagues at the University of California, Davis Medical Center are currently using to treat a number of conditions, including granulomas, papillomas, airway stenosis, and benign and malignant tracheal neoplasms. Called the Lightforce Gold laser, and manufactured by Medical Energy Inc. (www.medicalenergy.com ), it uses a wavelength of about 980 nm with a very small spot size of 0.1 mm and can be used in a single, multi-, or continuous mode with a wide range of power delivery of 0.1 to 20 watts, said Dr. Belafsky. This laser can be delivered through a very small (1 mm) flexible fiberoptic delivery system that makes it very amenable to in-office surgery through flexible endoscopes, he said.