Transoral Laryngeal Surgery Using the CO 2 Laser: Laboratory Experiments and Clinical Experience

Since the introduction of the CO 2 laser coupled to the Zeiss operating microscope in 1969, it has become apparent that this instrument is without equal for the carefully controlled removal of small laryngeal lesions. It has now also been shown experimentally and with some clinical confirmation that by using the CO 2 laser transorally all of the standard types of partial and excisional laryngeal surgery may be accomplished with minimal morbidity and without the use of tracheotomy. The major exception is that replacement of soft tissue is not possible. Therefore, procedures that remove sufficient amounts of soft tissue to compromise the sphincter function of the larynx should not be done transorally with the CO 2 laser. The instrument itself is almost deceptively simple to use. However, the unusual surgical approach and the changed appearance of tissue following laser vaporization may confuse the operator until considerable expertise has been gained in the animal laboratory. Nevertheless, the ability of the instrument to excise small or large areas of the larynx transorally with precision and with almost no resultant morbidity makes this effort worthwhile.