Advantage and disadvantage of KTP-532 laser tonsillectomy compared with conventional method

Objective: The purpose of this prospective study is to define the advantages and disadvantages of KTP laser tonsillectomy compared with those of the conventional method. Methods: Eighteen adult patients (ten male and eight female, ranging in age from 14 to 44 years) underwent KTP-532 laser tonsillectomy on one side and standard dissection surgery on the other side under general anesthesia. Results: By KTP laser tonsillectomy, there was a reduction in intraoperative blood loss and average time for removing one tonsil. On the second day of tonsillectomy, subjective pain on the KTP laser surgery side was less than that on the conventional surgery side. By the days 5–8, however, this effect disappeared and many patients indicated the laser side was more painful. There was no postoperative bleeding after KTP laser tonsillectomy. Laser surgery appeared to lead to slow wound healing during the whole post-operative course with significant difference compared with the conventional method. Disadvantages of postoperative pain and the possibility of secondary infection due to slow wound healing could be prevented by application of antibiotics and an anodyne. Conclusion: Considering safety and reliability during surgery, KTP laser was considered useful for adult tonsillectomy.     

KTP-532 laser in the management of rhinosporidiosis

Rhinosporidiosis, a difficult granulomatous disease of the nose is notorious for its high rate of recurrence and vascularity. Potassium Titanyl Phosphate (KTP) laserization of the mass seems to have provided an optimal solution in the management of this disease. We present our experience with the use of KTP-532 laser for this challenging disease.     

KTP-532 laser cordotomy for bilateral abductor paralysis

Various lateralization procedures have been described in the past to treat bilateral vocal cord paralysis. Though endoscopie lateralization gives good results in terms ofdecannulation rates, the postoperative voice quality is often poor. KTP-532 laser assisted posterior cordotomy was done in 3 cases. This preliminary study showd 100% decannulation rate and good post-operative voice quality. The latter was assessed both subjectively and objectively on VAGMI scales.     

Endoscopic KTP-532 laser assisted diverticulotomy for Zenker's diverticulum

Zenker's diverticulum, though counnon in western countries is uncommon in India. This diverticuham is an extension of umcosa through Killian's dehiscence. Various surgical methods have been described for the treatment of this condition including the use of lasers but none in Indian Journals. In this paper we describe a case of Zenker's diverticulum where diverticulotomy using KTP532 laser was successfully performed. Its advantages over other techniques are mentioned.     

Myringoplasty for anterior and subtotal perforations using KTP-532 laser

A retrospective study was performed on patients who underwent myringoplasty for either anterior or subtotal perforations over an 8-year period (from 1994 till 2004). We used the KTP-laser assisted anterior anchoring technique combining with anterior “pull-back” method. Patients’ ages ranged from 6–62 years (median 36.5). The mean follow-up period was 2.8 years (minimum 6 months). The audiological results were analysed with the “Pytel software”, which was developed in our department. As for the procedure, the drum remnant was freed from the malleus handle with the use of the laser and elevated out of it’s sulcus anterior-superiorly. Large fascia graft was fashioned with a split of 4–5 mm in the middle of one edge. The graft was placed using the underlay technique medial to the handle of the malleus. A pull-back tunnel was created at the border of the anterior quadrants to further facilitate the survival of the graft. In this series the graft taking rate was100%. Reperforation due to an undersized fascia was observed in one case. Post-operative audiological results indicated no bone conduction threshold elevation in any frequencies. Using the laser, cochlear trauma can be prevented, double fixation of the drum prevents lateralisation and blunting. Wide canalpalsty makes both the approach and the follow-up very easy. Thorough soft tissue and bone work is advantageous from the fascia taking rate point of view.*This paper was presented at the 5th EUFOS Congress, Rhodes, Greece, 11–16 September, 2004.     

CO2 and KTP-532 laser cordectomy for bilateral vocal fold paralysis

Laryngeal obstruction due to bilateral vocal fold paralysis has been treated in many different ways. The CO2 laser or KTP-532 laser endoscopic cordectomy described in this report is a slight modification of the posterior partial cordectomy proposed by Dennis and Kashima. This technique was used in 18 patients (14 with the CO2 and four with the KTP-532 laser). Prophylactic tracheostomy was performed pre-operatively. Post-operative results were excellent in nine cases, good in seven cases and poor in two cases who had to remain with a permanent tracheostomy tube with a speaking valve. The main complications noted were the formation of a granuloma (seven cases) and arytenoid oedema (six cases). Revision surgery was performed in the seven cases with granuloma formation and in the two with persistent oedema. The results and the post-operative findings from the use of the two lasers were similar.     

Results of KTP-532 laser and tendon preservation stapedotomy in otosclerosis-a preliminary report

Tendon preservation stapedotomy with or without KTP-532 laser has been performed on 25 rases Jrom November 1998 to February 2000. A study of the symptoms, demographic profile, audiological impairment, surgical treatment and the resultant hearing improvement after 3 weeks and 6 weeks was done. KTP-532 laser assisted cruratamy and stapedotomy was found to be easier than the conventional method. Insertion of the prosthesis was also found to be much easier because of tendon preservation.     

儿童单极电刀扁桃体切除术的临床应用

全身麻醉下行扁桃体切除术安全可靠，但术中出血相对较多，时间较长。我院自2003年4月至2004年5月采用单极电刀扁桃体切除术199例，发现术中出血明显减少，手术时间短。为全面系统地了解这种术式的特点，我们对36例患儿进行研究，现报告如下。     

"Ultrasound tonsillectomy" in comparison with conventional tonsillectomy

BACKGROUND AND OBJECTIVE: The postoperative convalescence after tonsillectomy is difficult because of a high rate of secondary hemorrhages and severe pain. The Ultracision Harmonic Scalpel cuts in the longitudinal direction and coagulates simultaneously by means of a 55.500 Hz vibrating blade. A randomized prospective simple blind study was conceived to compare the advantages and disadvantages of the "Ultrasound Tonsillectomy" with the conventional method. PATIENTS: Between 8/1999 and 3/2000 25 tonsillectomies were performed with the Ultracision (TEuc-group) and 25 with conventional methods (TEkonv-group). The age of the patients was between 18 and 65 years. RESULTS: The median intraoperative blood loss in the TEuc-group was significantly lower than the TEkonv-group (19.0 g/176.0 g), the pain symptoms were comparatively less. On the other hand postoperative blood losses of the TEuc-group were clearly higher (7/25 vs. 3/25), wounds healed more slowly, the development of the wound covering and the swelling of the uvula were significantly larger. CONCLUSIONS: Based on the results of the study the ultrasound technique is not superior to the conventional tonsillectomy.     

Complications of tonsillectomy: a comparison of techniques

OBJECTIVE: To compare the postoperative complications of intracapsular tonsillectomy using a microdebrider with traditional electrodissection tonsillectomy. DESIGN: Retrospective chart review. SETTING: Tertiary care pediatric referral center. PATIENTS: The medical records of 2944 patients undergoing tonsillectomy with or without adenoidectomy at our institution between January 1, 2002, and May 31, 2005, were reviewed. MAIN OUTCOME MEASURES: Incidence of delayed postoperative hemorrhage, return to the hospital or emergency department for pain or dehydration, and the need for revision surgery. RESULTS: There were 1731 patients in the intracapsular tonsillectomy group and 1212 in the traditional electrodissection tonsillectomy group. The incidence of delayed hemorrhage was 1.1% in the intracapsular tonsillectomy group and 3.4% in the traditional electrodissection tonsillectomy group (P < .001). For delayed hemorrhage requiring treatment in the operating room for control, the incidence was 0.5% in the intracapsular tonsillectomy group and 2.1% in the traditional electrodissection tonsillectomy group (P < .001). Treatment in the emergency department or hospital for pain or dehydration was necessary in 3.0% of the intracapsular tonsillectomy group and in 5.4% of the traditional electrodissection tonsillectomy group (P = .002). Eleven patients (0.64%) in the intracapsular tonsillectomy group required revision tonsillectomy. CONCLUSION: Intracapsular tonsillectomy has a lower incidence of postoperative hemorrhage and pain leading to hospital-based evaluation compared with traditional electrodissection tonsillectomy.     

Postoperative pain in tonsillectomy: comparison of ultrasonic tonsillectomy versus blunt dissection tonsillectomy

Intraoperative blood loss, postoperative pain, and postoperative appetite were compared between 15 adult patients who underwent tonsillectomy using an ultrasonically activated scalpel (UT) and 15 adult patients who underwent blunt dissection tonsillectomy with cold steel instruments (BT). The average intraoperative blood loss of the UT group was 4.6 +/- 1.9 ml (mean +/- standard deviation), while that of BT group was 41.9 +/- 12.9 ml. This difference was highly statistically significant (p < 0.0001). In contrast, there were no significant differences in the VAS pain and appetite scores between patients who underwent UT and those who underwent BT on any day in the 6-day postoperative period. Our current results show that UT is a safe technique, and we believe that it should be considered a useful alternative for tonsil surgery.     

Lingual tonsillectomy in a child with obstructive sleep apnea: a novel technique

We report on a case of lingual tonsillar hyperplasia contributing to refractory obstructive sleep apnea in a 5-year-old patient. We describe a novel technique utilizing suspension laryngoscopy and a laryngeal angled shaver to remove obstructive lingual tonsillar tissue. We review the available techniques for lingual tonsillectomy and propose theoretical advantages to the novel approach.     

Office-based laryngeal laser surgery with the 532-nm pulsed-potassium-titanyl-phosphate laser

PURPOSE OF REVIEW: Office-based laryngeal laser surgery is a recent innovation. It is emerging as a reliable and practical method of treating a number of laryngeal lesions, which is increasingly popular in the US and abroad. The 532-nm pulsed-potassium-titanyl-phosphate laser has become our laser of choice in treating vocal-fold lesions and diseases for a number of transparent and practical reasons. RECENT FINDINGS: Fiber-based lasers and distal-chip flexible endoscopy have facilitated a new style of surgery. Epithelial diseases such as dysplasia and papillomatosis are well suited for this treatment. Although the initial angiolytic laser used in the larynx was a 585-nm pulsed-dye laser, the solid-state 532-nm pulsed-potassium-titanyl-phosphate laser has been demonstrated to be more effective clinically, more reliable structurally and less expensive. SUMMARY: Technologies to enhance laryngoscopic imaging and lasers, along with socioeconomic forces, should lead to increasing numbers of laryngeal procedures being done in the office with local anesthesia. The 532-nm pulsed-potassium-titanyl-phosphate laser has emerged thus far as the optimal technology for treating phonatory mucosa although further development is likely.     

Intracapsular vs. extracapsular tonsillectomy: a comparison of pain

OBJECTIVE: To measure differences in postoperative pain in children undergoing intracapsular tonsillectomy vs. extracapsular tonsillectomy. STUDY DESIGN: Prospective clinical trial carried out at a tertiary children's hospital over 1 year. METHODS: The study included 43 patients age 5 to 19 years with adenotonsillar hypertrophy, 27 undergoing extracapsular tonsillectomy and 16 undergoing intracapsular tonsillectomy. Tonsillectomy was performed in either an intracapsular or extracapsular fashion using bipolar electrosurgical scissors and monopolar suction cautery for hemostasis. Residents under faculty supervision performed all operations. Postoperative pain was assessed using the Wong-Baker Faces Pain Scale through postoperative day 10. The patients recorded in a standardized diary pain scores and analgesic use. The main outcome measure was postoperative pain as measured by the Wong-Baker Faces Pain Scale. The quantity of postoperative pain medicine consumed was a secondary outcome measure. RESULTS: Average postoperative pain for extracapsular tonsillectomy was 5.21 on a 10-point scale versus 2.75 for intracapsular tonsillectomy (P < .0001). CONCLUSIONS: Intracapsular tonsillectomy with bipolar scissors results in less postoperative pain than extracapsular tonsillectomy with bipolar scissors in children age 5 to 19 years.     

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy

CONCLUSION: There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. OBJECTIVE: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. MATERIAL AND METHODS: All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years). RESULTS: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of "selected" elective tonsillectomies. The difference between these two rates was not significant (p = 0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.     

Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis

BACKGROUND: Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. OBJECTIVE: To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. METHODS: A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. RESULTS: The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. CONCLUSIONS: Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.     

Small fenestra stapedotomies with and without KTP laser: a comparison

The results of 33 small fenestra stapedotomies performed using conventional techniques were compared with the results of 33 stapedotomies performed using the argon or KTP laser. The ossicular chain was reconstructed using a Teflon wire piston of 0.6 mm diameter, and follow-up was at least 1 year. Over-closure of the air-bone gap or closure to within 10 dB was accomplished in 91% of the laser-treated group versus 72% of the conventionally treated group (p less than 0.10). The hearing results were statistically better in the laser group (p less than 0.05). Transient delayed vestibular symptoms, lasting from 1 to 3 weeks, were present in 39% of the laser-treated group and in 12% of the patients treated by conventional techniques (p less than 0.05). The KTP laser stapedotomy, using a micromanipulator mounted on the microscope, is a safe, efficient technique that reduces some of the technical difficulties associated with conventional stapes surgery. The main advantage of the laser is that it enables the surgeon to make an atraumatic, bloodless opening in a fixed or mobile stapes footplate without mechanical manipulation of the stapes. Using a lower wattage to vaporize the footplate and waiting several seconds between laser bursts may decrease the incidence of postoperative vestibular symptoms. The use of the KTP laser in stapes surgery represents a major advance in surgery for otosclerosis.