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