Transoral laser surgery (transoral laser microsurgery) treats tumours of the voice box and throat from the inside, through the mouth, without an incision in the neck. It combines an operating microscope, a laryngoscope that holds the mouth and throat open, and a carbon dioxide laser that cuts tissue precisely while sealing small blood vessels.
What it is
The technique is used for early cancers of the vocal cords and of other parts of the larynx and lower throat, for precancerous lesions, and for some benign conditions such as papillomas or scarring that narrows the airway. The tumour is removed with a narrow margin of healthy tissue, so that as much of the normal larynx as possible is preserved. Larger tumours, or tumours that cannot be exposed through the mouth, are treated with open surgery or radiotherapy instead.
Who it is for
Adults with a small or early cancer of the larynx or throat confirmed by biopsy, adults with a suspicious lesion of the vocal cords, and selected adults with benign lesions of the larynx or airway. The mouth must open, and the neck bend back, far enough for the larynx to be reached.
Symptoms and diagnosis
Persistent hoarseness is the usual reason a vocal cord lesion is found. Examination with a flexible endoscope in the consultation room shows the lesion and the movement of the vocal cords, and stroboscopy or narrow-band imaging can add detail. A biopsy under anaesthesia confirms the diagnosis, and CT or MRI is used when deeper spread is possible.
How the operation is done
Under general anaesthesia, a laryngoscope is passed through the mouth and fixed in position so that the larynx is seen through the operating microscope. The laser beam is guided under high magnification, and the tumour is removed in one piece or in a few pieces, which are sent to the pathologist so that the margins can be assessed. Because the beam seals small vessels as it cuts, bleeding and swelling are usually slight. The operation is usually short, and a breathing opening in the neck is not normally needed.
Recovery
Most people go home the same day or the next morning and can drink and eat soft foods within hours. The throat is sore for a few days, and the voice is hoarse until the surface heals over a few weeks. Voice rest is advised at first, followed by gentle use; voice therapy is arranged when it will help. Follow-up endoscopies check healing and watch for any recurrence.
How Prof. Hafız works
Transoral laser surgery is one of the focus areas of Prof. Hafız’s practice, alongside laryngeal cancer surgery and airway surgery, and he has contributed a chapter on powered instruments in ear, nose and throat surgery to a Turkish textbook. Whether a tumour is suitable for the laser, and what the alternatives are, is assessed at the consultation and explained together with the expected effect on the voice.