see also: Video of setup: Blue Light Laser (445 nm wavelength) Video of Setup and Equipment
- Video of Laser Plume Containment: KTP Laser Treatment through Flexible Transnasal Laryngoscopy in the COVID Era Setup in Main Operating Room for RRP
- Details about Blue Light Laser: Blue Light Laser (445 nm wavelength) - Settings, Application, and Research
- Publication addressing laser plume containment with negative pressure face shield: https://onlinelibrary.wiley.com/doi/full/10.1002/lio2.526
A. Modified Operative Note
Preop Dx: RRP affecting left vocal cord
Postop Dx: Same
Procedure: Awake sitting right nostril transnasal flexible laryngoscopy with blue light laser treatment to papilloma with forceps resection
Surgeon: Hoffman Asst: XXXX
Anesthesia: 4% lidocaine 1% phenylephrine spray x 3 to right nostril; 1.5 cc of 4% lidocaine dripped on to laryngeal introitus through 25 gauge sclerotherapy needle in working channel of scope
Findings: as per photos below
Laser setting: 8 watts, 20 msec pulses, 300 ms interval
26.9 total joules (18.2 Joules initial treatment then biopsy followed by 8.9 joules)
Initial with contact
Final 8.9 joules without contact - estimated laser tip distance to lesion of 3 mm
B. Image of Settings in Action
C. Pathology Report
Diagnosis:
Larynx, left vocal cord, excision:
Squamous papilloma with mild dysplasia.
D. Equipment
- Olympus tower with BF-P190-003 Slim Bronchoscope with working channel
- Laser Fiber - A.R.C. HiFlex Fiber 400 um, u.c.
- Negative Pressure Face Shield (see: Laser plume containment during flexible transnasal laryngoscopy)
- EndoJaw Disposable Biopsy Forceps (minimal channel size 2.0 mm)
- 25 ga (0.5 mm) x 200 cm Injection Therapy Needle Catheter (Boston Scientific InterjectTM)
E. Medications
4% topical lidocaine (delivered via 10 cc syringe topically to larynx through 25 gauge sclerotherapy needle)
Atomized 1 cc of 4% lidocaine with 1% phenylephrine spray to nose x 3 (if narrow nose, consider preceding spray with Afrin® (oxymetazoline), possibly packing nose with soaked neurosurgical cottonoids)
May consider superior laryngeal nerve blocks for more extensive work
F. References
Nguyen DD, Pang J-Y, Madill C, and Novakovic D: Effects of 445-nm Laser on Vessels of Chick Chorioallantoic Membrane with Implications to Microlaryngeal Laser Surgery Laryngoscope, 00:1-7, 2021
Hoffman HT, Miller RM, Walsh JE, Stegall HR, Diekema DJ. Negative pressure face shield for flexible laryngoscopy in the COVID-19 era. Laryngoscope Investig Otolaryngol. 2020 Jul 29;5(4):718-726. doi: 10.1002/lio2.437. PMID: 32864444; PMCID: PMC7444791.
Hoffman HT, Walsh JE, Pratt A, Miller RM, Schwalje A, Stegall HR, Nonnenmann M. Laser plume containment during flexible transnasal laryngoscopy. Laryngoscope Investig Otolaryngol. 2021 Feb 5;6(2):234–43. doi: 10.1002/lio2.526. Epub ahead of print. PMID: 33821216; PMCID: PMC8013799.
Karkos PD, Koskinas IS, Triaridis S, Constantinidis J. Lasers in Οtolaryngology: A Laser Odyssey From Carbon Dioxide to True Blue. Ear, Nose & Throat Journal. 2021;100(1_suppl):1S-3S. doi:10.1177/0145561320951681
BritaMed, Inc. The revolutionary WOLF TruBlue laser. November 19, 2018. https://www.slideshare.net/BritaMed/the-revolutionary-wolf-trublue-laser . Accessed September 7, 2021.
Hess MM, Fleischer S, Ernstberger M. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties. Eur Arch Otorhinolaryngol 2018;275:1557–1567.
Mallur PS, Johns MM III, Amin MR, Rosen CA. Proposed classification system for reporting 532-nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions. Laryngoscope 2014; 124(5):1170–1175. https://doi.org/10.1002/lary.22451
Reichelt J, Winter J, Meister J, Frentzen M, Kraus D. A novel blue light laser system for surgical applications in dentistry: evaluation of specific laser-tissue interactions in monolayer cultures. Clin Oral Investig 2017;21:985–994
Braun A, Berthold M, Frankenberger R. The 445-nm semiconductor laser in dentistry—introduction of a new wavelength. Quintessenz 2015;66:205–211
Braun A, Kettner M, Berthold M, Wenzler JS, Heymann PGB,Frankenberger R. Efficiency of soft tissue incision with a novel 445-nmsemiconductor laser. Lasers Med Sci 2018;33:27–33
Frentzen M, Kraus D, Reichelt J, et al. A Novel Blue Light Diode Laser (445nm) for Dental Application. Laser: International Magazine for Laser in Dentistry; 2016:6–13.
Lin RJ, Iakovlev V, Streutker C, Lee D, Al-Ali M, Anderson J. Blue Light Laser Results in Less Vocal Fold Scarring Compared to KTP Laser in Normal Rat Vocal Folds. Laryngoscope. 2021 Apr;131(4):853-858. doi: 10.1002/lary.28892. Epub 2020 Aug 4. PMID: 32750168.
Miller BJ, Abdelhamid A, Karagama Y. Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice. Ear, Nose & Throat Journal. 2021;100(1_suppl):105S-112S. doi:10.1177/0145561320960544
Hantzakos AG, Khan M. Office Laser Laryngology: A Paradigm Shift. Ear, Nose & Throat Journal. 2021;100(1_suppl):59S-62S. doi:10.1177/0145561320930648
Eigsti RL, Bayan SL, Robinson RA, Hoffman HT. Histologic effect of the potassium-titanyl phosphorous laser on laryngeal papilloma. Laryngoscope Investig Otolaryngol. 2019 Feb 14;4(3):323-327. doi: 10.1002/lio2.250. PMID: 32025568; PMCID: PMC6997934.
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