Transoral laryngeal videosurgery under the direct guidance of narrow band imaging: a preliminary report
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BRIEF REPORT
Transoral laryngeal videosurgery under the direct guidance of narrow band imaging: a preliminary report Luca Giovanni Locatello 1
&
Giandomenico Maggiore 1 & Chiara Bruno 1 & Oreste Gallo 1
Received: 24 February 2020 / Accepted: 16 April 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Introduction Transoral CO2 laser-assisted microsurgery (TLM) or videosurgery (TLV) is a fundamental tool in the armamentarium of every otorhinolaryngologist for both benign and malignant laryngeal pathology [1, 2]. In the last decades, several technical improvements have been introduced and, notably, narrow-band imaging (NBI) is a new technology which allows us, by the light of specific blue and green wavelengths, to enhance the details of the vascular patterns at the mucosal surfaces [3]. In the most recent literature, different and reproducible patterns, which can help to distinguish between malignant and benign lesions, have been defined in the head and neck region [4–6]. Beyond the optical diagnosis, some authors have tried to use such technique to enhance the visualization of the tumor and, ultimately, of the surgical margins during TLM treatment for early glottic cancer [7]. The limits of the suspicious area are therefore delineated at the beginning of the procedure under NBI light and then, resection is completed under normal white light [7]. We would like to present a preliminary report of a modified TLV technique that we have devised in order to perform several transoral procedures under the direct and continuous guidance of NBI.
Materials and methods Patients were enrolled at the Department of Otorhinolaryngology, Careggi University Hospital in Florence, Italy in the period from September to November 2019. All TLV procedures were carried out under general
anesthesia after orotracheal intubation with a laser-safe endotracheal tube (diameters, 4.5–5.5 mm; Xomed; Medtronic, Paris, France). Informed written consent was obtained before surgery that was performed by two of the authors who have a long-standing experience in TLM and TLV procedures. Figure 1 shows the basic operating room setup to perform TLV under NBI guidance. As it can be seen, we implemented the Kantor-Berci video-laryngoscope plus Hopkins® Straight Forward Telescope 15° (Karl Storz GmbH and Company, Tuttlingen, Germany) along with Visera® Elite Video Processor OTV-S190 and Visera® Elite Xenon Light Source CLV-S190 (Olympus Medical System Corporation, Tokyo, Japan) with high-definition television (HDTV). Inclusion criteria were the need of a transoral CO2 laser-assisted procedure in the pharyngolaryngeal region and an informed written consent. Patients that had an insufficient exposure, those who required laryngoscopes other than the Kantor-Berci due to anatomical constraints, or that showed an excessive amount of blood onto or near the lesion of interest were excluded. Transoral laser surgery was performed using a CO2 laser (SmartXide [2] ENT, DEKA Corporation, Calenzano, Italy) combined with a Hybrid EasySpot micromanipulato
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