Laser Microsurgery

Transoral laser microsurgery is a special technique used to remove tumors in the larynx and pharynx through the mouth. The procedure is useful for the treatment of small and medium-sized tumors in the mouth and throat. (See Video of Trans-oral Laser Microsurgery.)

Laser microsurgery has several advantages over conventional, open surgery:

• More normal tissue is saved.
• Normal tissues do not need to be divided to reach the tumor, (as in standard, open surgery).
• Patients spend less time in the hospital, (though the time in the operating room may be longer.)
• Patients are more likely to retain swallowing and speech function.
  Fewer patients require a tracheostomy.
• Conventional surgery and radiation remain options at a later time if needed.

Transoral laser microsurgery employs endoscopes to view the throat and voicebox. Looking through the microscope, the surgeon directs the laser and divides the tumor into pieces that can be removed through the endoscope. Selected "margins," (edges), are marked and checked during the operation by a pathologist who examines the margins for microscopic tumor not visible to the surgeon. Some weeks later, a "second-look" procedure may be done to check for any early recurrence of cancer.

Although dividing a tumor into smaller pieces has not been considered appropriate by conventional surgical principle, experience over the last 20 years has shown it to be an acceptable mode of therapy.

Head and neck tumors never grow in a predictable way, with each tumor unique in its pattern of invasion. Use of the microscope allows Dr. Caruana to understand the anatomy around the growth and to be precise in tumor removal and may also tell him when radiation is not needed. If he determines that a tumor is superficial and that there is little chance of spread to the neck, radiotherapy can be avoided.

Patients are carefully evaluated to determine if transoral laser microsurgery is appropriate. Sometimes, microsurgery can be used for palliative treatment after cancer has spread and it can be an option for those whose health contraindicates traditional surgery.

Laser microsurgery can be used to remove samll and medium cancers of the:

• Base of the tongue
• Floor of the mouth
• Epiglottis
• Larynx
• Palate
• Pharynx (throat)
• Tonsils
• Tongue
• Vocal cords

Laser microsurgery cannot be used to treat all tumors. It may be a poor choice when:

• The tumor is too large.
• The tumor is continuous with cancer in the neck and needs extensive reconstructive surgery.
• The patient has had radiation therapy or other treatments that compromise the ability of the tissue to heal.