Nd: YAG laser scalpel compared with conventional techniques in head and neck cancer surgery

Many theoretical advantages over conventional surgical techniques have been attributed to the Nd: YAG contact laser. Clinically significant differences in perioperative results between the Nd: YAG contact laser and standard surgery, however, are not well defined. The present study was undertaken to evaluate the Nd: YAG contact laser compared with standard scalpel and/or electrocautery in curative operations for head and neck cancer. Clinical records of 36 patients undergoing head and neck cancer surgery were reviewed retrospectively. Patients were studied in three groups: 9 previously irradiated patients operated upon using the Nd: YAG laser (Nd:YAG); 9 previously irradiated patients operated upon using conventional techniques (conventional/RT); 18 nonirradiated patients operated upon using conventional techniques (conventional/no RT). These groups underwent 14,14, and 25 procedures, respectively. Differences between the Nd: YAG, conventional/RT, and conventional/no RT groups regarding cancer staging, age, procedures performed, operative time, intraoperative blood loss, and hospital and ICU stay were not statistically significant. Preoperative radiotherapy dosages in the Nd: YAG and conventional/RT groups were similar (5,127 ± 842 vs. 604 ± 2,373 cGy). Postoperative morbidity in Nd: YAG patients (11%) was similar to that of the conventional/no RT group (17%) and was significantly reduced compared to conventional/RT (11% vs. 56%, P < 0.05). Clinical outcome, including operative time, blood loss, and hospital and ICU stay using the Nd: YAG contact laser in curative operations on previously irradiated patients with head and neck cancer, is equal to that of conventional surgical techniques, with or without preoperative radiotherapy. Among patients operated upon after receiving radiation therapy for head and neck cancer, the Nd: YAG contact laser significantly reduces postoperative morbidity. The data indicate that the Nd: YAG contact laser is an effective surgical technique in head and neck oncology. © 1994 Wiley-Liss, inc.