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. 2021 Jun;41(3):243-247.
doi: 10.14639/0392-100X-N0935. Epub 2020 Dec 29.

Office-based procedures in laryngology

Marta Filauro  1   2   3 , Alberto Vallin  1   2 , Marco Fragale  1   2 , Claudio Sampieri  1   2 , Luca Guastini  1   2 , Francesco Mora  1   2 , Giorgio Peretti  1   2
Affiliations

Office-based procedures in laryngology

Marta Filauro et al. Acta Otorhinolaryngol Ital. 2021 Jun.

Abstract
in English, Italian

Objective: Development of transnasal fiberoptic laryngoscopy, integration of an operative channel (OC), the advent of high-definition television imaging, with improvements in laser technology, cleared the way for office-based laryngology. Three treatment categories can be identified: bioendoscopy-guided biopsy; laryngeal injection; laser-assisted surgery.

Methods: 26 patients underwent OBPs at the Otolaryngology Clinic of IRCCS Policlinico San Martino, Genoa, Italy. Sixty-eight procedures were performed: 60 for recurrent respiratory papillomatosis (RRP), 5 for unilateral vocal fold paralysis (UVFP) and 3 for glottic leukoplakias. Neoblucaine 5% was administrated through the operative channel, for local anaesthesia. All procedures were carried out with the physician standing behind the patient. Narrow band imaging (NBI - Olympus Medical) or i-scan (Pentax Medical) were used to enhance the accuracy of the biopsy thanks to identification of atypical vascular patterns. Laryngeal injections were made using a 25G flexible needle. Opera Evo (Quanta system IEC/EN 60825-1:2007) is a hybrid fibre laser that is used for "blanching" and vaporisation of RRP lesions and to treat selected leukoplakias that were previously biopsied.

Conclusions: No major complications occurred during the procedures.

Procedure ambulatoriali in laringologia.

Oggetto: Lo sviluppo della fibrolaringoscopia transnasale, l’integrazione del canale operativo e l’avvento dell’alta definizione, associato ai miglioramenti della tecnologia laser, hanno permesso la diffusione delle procedure laringologiche eseguite ambulatorialmente. Esistono 3 categorie di trattamenti: biopsie guidate dalla bioendoscopia, iniezioni endolaringee e chirurgia laser-assistita.

Metodi: 26 pazienti sono stati sottoposti a trattamenti ambulatoriali presso la Clinica Otorinolaringoiatrica dell’IRCCS Policlinico San Martino di Genova, Italia. Sono state eseguite 68 procedure: 60 per papillomatosi respiratoria ricorrente, 5 per paralisi unilaterale della corda vocale e 3 per leucoplachie glottiche. Tutte le procedure sono state eseguite posizionandosi dietro il paziente. Per aumentare l’accuratezza della presa bioptica, abbiamo utilizzato la Narrow band imaging (NBI – Olympus Medical) o i-scan (Pentax Medical). Le iniezioni endolaringee sono state eseguite con un ago flessibile da 25G. Per eseguire la vaporizzazione delle lesioni papillomatose e per trattare le leleucoplachie selezionate è stato utilizzato il laser a fibra ibrido Opera Evo (Quanta system IEC/EN 60825-1:2007).

Conclusioni: Nessuna complicanza maggiore è incorsa durante le procedure.

Keywords: injection; laryngology; office-based procedures; recurrent respiratory papillomatosis; videolaryngoscopy.

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Conflict of interest statement

Conflict of interest

The Authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
(A) Neoblucaine 5%; (B) From the left side: endoscopic forceps, 5% neoblucaine, tullio-diode laser fibre and bevacizumab; (C) Opera Evo hybrid laser.
Figure 2.
Figure 2.
(A) Local anaesthesia into patient’s nose; (B) Local anaesthesia through the operative channel; (C) Laser fibre insertionthrough the operative channel; (D) Endoscopic forceps insertion through the operative channel.
Figure 3.
Figure 3.
(A) Papilloma laser surgery; (B) Vapourised tissue asportation; (C) Submucosal bevacizumab injection; (D) Bioendoscopy-guided biopsy; (E) Glottic leukoplakia vaporisation; (F) Three-month white light follow-up; (G) Three-month NBI follow-up; (H) Hyaluronic acid injection into the vocal ligament.
See this image and copyright information in PMC

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