Transnasal Office-Based Laryngeal Surgery Using a Distal-Chip Endoscope with a Working Channel

Abstract

Objectives:

The advanced technology of distal-chip flexible naso-endoscope (“chip-on-the-tip” processor), with high resolution digital video recording, allows for more accurate diagnosis, treatment, and follow-up of patients with laryngeal disease. Using this instrument with a working channel introduces a new surgical tool, allowing for a variety of transnasal surgical procedures under topical anesthesia. The aims of the study were to: (1) Describe the spectrum of treatment options for laryngeal pathologies using distal-chip flexible naso-endoscope. (2) Describe the variety of accessories that can be used. (3) Assess the relative advantages, limitations and risks.

Methods:

A retrospective series reviewing medical files of patients treated with the distal-chip endoscope during 2010 through 2013 for benign laryngeal conditions. Compliance, complications, surgical notes and long term outcome were documented.

Results:

Forty-six patients were treated by office-based laryngeal surgery during the study period. Surgeries performed: Diagnostic biopsies of the glottis, subglottis, and trachea and treatment of papillomatosis, fibrovascular lesions, granulation tissue, keratosis, stenosis, vocal cord paralysis, and cysts. Instruments used: anesthesia catheter, grasping forceps, injection needles, and lasers. No significant adverse effects or complications were documented. The only factor influencing procedure success was patient cooperation and ability to resist gag reflex. Most patients had transnasal surgery; few had combined transnasal and transoral procedures.

Conclusions:

The distal chip endoscope with a working channel enables the laryngeal surgeon to perform relatively complex procedures as an office-based surgery while avoiding the consequences of general anesthesia and operating room costs.