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Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy KTP Laser Treatment of Hemorrhagic Polyp in COVID Era

return to: Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy to Mitigate Dispersion of Bioaerosol in COVID Era

KTP Laser Treatment through Flexible Transnasal Laryngoscopy in the COVID Era Setup in Main Operating Room for RRP

KTP Laser for the Larynx

KTP (potassium-titanyl-phosphate) laser in office treatment of vocal fold polyps

Click on thumbnails above and advance for full image display

 

 

 

Modified Operative Note

Preop Dx: Left vocal cord polyp, dysphonia

Postop Dx: Same

Procedure: Transnasal KTP laser and resection of left vocal fold polyp 64 J (30 Watts, 15 msec pulses, 2 pps) with use of Negative Pressure Face Shield (NPFS)

                   Bilateral superior laryngeal nerve blocks (1cc to each side of 2% lidocaine with 1:100,000 epinephrine) (see: Superior Laryngeal Nerve Blocks Instruction Video)

Anesthesia: Glycopyrrolate 1 mg by mouth 1 1/2 hours preop;

                     Bilateral superior laryngeal nerve blocks as above;

                     Left nostril spray x 3 with 4% lidocaine 1% phenylephrine;

                     Topical 4% lidocaine to larynx through 25 gauge sclerotherapy needle to vc's and subglottis (1.5 cc)

Findings: In addition to photos above (including setup)

     Use of the Olympus Slim Bronchoscope (BF-P190 - 003)

 

through the left nostril via the NPFS (Neptune suction at 520 mm Hg)

 

permitted delivery of 4% topic lidocaine

 

through the 25 gauge sclerotherapy needle

KTPV,1 to surrounding blood vessels

 

KTP3,4 directly to hemorrhagic polyp

 

Following resection with use of disposable EndoJaw Olympus forceps outer diameter 1.9 mm  (minimal channel size of 2.0 mm)

 

, KTP V,1 to underlying blood vessels

 

Total 64 J (30 W, 15 msec pulses, 2 pulses per second)

Laser Fiber:

References:

Tibbetts KM, Simpson CB. Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology. Otolaryngol Clin North Am. 2019 Jun;52(3):537-557. doi: 10.1016/j.otc.2019.02.011. Epub 2019 Mar 26. PMID: 30922560.

Madden L.L., Ward J., Ward A., et al: A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. Laryngoscope 2017; 127: pp. 1845-1849