Transoral laser microsurgery (TOLMS) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. In recent years, CO2 TOLMS has received a great consensus, as the use of CO2 TOLMS as a primary treatment is more cost-effective than open partial laryngectomy or radiotherapy and it is usually performed as a day-case procedure. The use of TOLMS has considerably improved the performance of ENT microsurgery. Today CO2 laser is universally recognized as the gold standard for mininvasive head and neck applications.
Although good surgical outcomes can be obtained from cold surgery, as larynx biopsy, laser surgery possess some physiological and technical advantages. Lasers are used to treat pathologies such as stenoses, recurrent respiratory papillomatosis (RRP), leukoplakia, nodules, malignant laryngeal disease, polypoid degeneration (Reinke¿s edema), and granulomas for which antireflux treatment is ineffective.
Besides being convenient and exact, lasers offer surgeons an opportunity for unobstructed vision of the operation field with minimal tissue manipulation and a longer working distance. Decreased risk of postoperative bleeding, increased sterility, minimal surrounding tissue damage, and better intraoperative hemostasis are among the potential benefits of laser surgery. Although fewer complications, side-effects, and better postoperative voice quality have been reported, this is largely technique-dependent. Lasers can be more cost-effective than cold surgeries when managing laryngeal tumors, as they afford briefer hospital stays and shorter wound recovery periods, particularly for patients with laryngeal cancer. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation.