Feasibility and safety of THRIVE in transoral laser microsurgery

Abstract

Objective: Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) presents obvious advantage in laryngeal surgery and Transoral Laser Microsurgery (TLM). Airway fire represents a rare complication of TLM and may be the most important limitation in the use of THRIVE. The objective was to evaluate the different operating conditions of the TLM with THRIVE with regard to fire risk.

Experiment: In this report, we assessed the risk of fire by varying the Fraction of Inspired Oxygen (FiO2), the Laser Energy, and the placement of endolaryngeal surgical and ventilatory equipment in a porcine model for TLM.

Results: Fire, sparks and smoke were reported. No combustion occurred with THRIVE in the absence of an endolaryngeal material. Fire occurred systematically while delivering between 3 and 5 W Carbon dioxide (CO2) Laser direct shot on a dry laryngeal cotton. Conclusion THRIVE-TLM should never be performed using a dry cotton or a plastic endolaryngeal material.

Keywords: Apneic oxygenation; High flow nasal oxygen; Laser; Otorhinolaryngology; THRIVE; Transoral laryngeal microsurgery.