return to: KTP Laser for the Larynx; KTP Laser for RRP local anesthesia case example; KTP laser for papilloma microdirect laryngoscopy; Two Nostril Approach to Laryngeal Biopsies and KTP Lasing Instruction Video

Video:

Modified Operative Note

I met with xxx preop (please see letter with all questions addressed for plan transnasal KTP laser and biopsy).

Procedure: Transnasal KTP vaporization of laryngeal papilloma with resection (biopsy) with forceps

Preop Diagnosis: Dysphonia with recurrent respiratory papillomatosis (RRP)

Postop Diagnosis: Same

Surgeon: xxxx

Assistant: xxxxx

Anesthesia:

Bilateral superior laryngeal nerve blocks (2% lidocaine with 1:100,000 epinephrine injected to a volume of 1 cc midway between upper border of thyroid cartilage and hyoid bone posterolaterally).

Decongestion of left nostril with Afrin followed by 2 separate sprays of 4% lidocaine with phenylephrine and applied on a neurosurgical Cottonoid a total of 2 cc of 4% lidocaine dripped onto the supraglottic and glottic and immediate subglottic larynx with a 25-gauge sclerotherapy needle through the VT scope.

Description of Procedure:

Following identification the patient informed consent and a brief timeout in the surgery center with the patient in the sitting position the straightened Olympus VT transnasal scope was preloaded a primed 25 gauge sclerotherapy needle to instill 4% lidocaine to the the supraglottic, glottic and subglottic larynx.

The KTP laser fiber (having been previously tested, employing 10 joules to do the testing) was that placed through the straightened VT scope. KTP laser settings of 30 W 15 ms pulses 2 pulses per second were used to deliver 52 J to the left sided laryngeal papilloma (right appeared clear) in a KTP for mode with papilloma removed with the laser tip and sent for pathology (called "biopsy #1 with lasing".  

Biopsy forceps were then used to debulk the lesion further and sent as a specimen called biopsy #2 (with biopsy forceps) further lasing was then performed delivering additional 32 J to a grand total of 84 J delivered.

The vocal fold was then ‘smoothed’ with further debulking with biopsy forceps rendering a smooth contour to the vocal fold and normal voicing produced.

The patient tolerated the procedure well and was observed in clinic for ½ hour before discharge home with identical follow-up procedure targeted in 3 months.