August 1, 2005 New endoscopic techniques allow doctors to operate patient's throats in the office, without putting them to sleep. Operating with several types of lasers through fiber optics, doctors can now remove growths such as vocal nodules, polyps and cysts -- cases that previously required admission into the hospital and full operating rooms.
WINSTON-SALEM, N.C.--New technology is clearing the way for easier, safer and less-expensive surgeries for some patients.
Just a few months ago, this laser procedure to remove growths from Joyce Douglas's airway was much more dangerous than it is today. That's because it had to be done in an operating room with general anesthesia.
Now, fiber-optic technology is making it possible for the treatment to be done right in the doctor's office with Douglas wide awake.
"We're getting better results, at less cost, without an anesthetic here in the office," says otolaryngologist Jamie Koufman, who is director of The Center for Voice and Swallowing Disorders and Professor of Otolaryngology at Wake Forest University in Winston-Salem, N.C.
Dr. Koufman is pioneering the procedure. She uses two different lasers. First, a carbon-dioxide laser is threaded up the patient's nose inside this tiny optical fiber. This laser removes the growth. Then a pulsed-dye laser helps prevent new growths from forming. Guiding the whole procedure is a high-resolution fiber-optic camera on the tip of the scope.
"We have the ability to go down into the lung and go between the vocal folds to places that are very difficult to get at -- even in the operating room," Dr. Koufman tells DBIS.
For Douglas, the new treatment is a godsend. Her recurrent growths obstructed her breathing for more than 35 years. She says, "My breathing, I feel like, is a lot better with the new laser that they're using," an improvement she can feel with each and every breath she takes.
The same approach will work for more than 50 percent of all surgeries to remove vocal nodules, polyps and cysts. The pulsed-dye laser is already FDA approved, and the FDA is expected to approve the carbon-dioxide laser as early as this fall.
BACKGROUND: A new procedure combining two different lasers can remove growths from the airway of a patient without general anesthesia, and it can be done right in a doctor's office. Before this, the equipment required for the surgery could only be used in the operating room with general anesthesia. The new procedure can be used for most throat surgeries.
HOW IT WORKS: Two different lasers are used in combination. A carbon-dioxide (CO2) laser removes the growth in the voice box and the airway to the lungs. Then a pulsed-dye laser is used to treat the base on the growths so that they don't re-occur. Each laser is guided by a high-resolution video-endoscope and the entire system is delivered to the patient through a tiny tube that is placed in the nose.
WHAT CAUSES GROWTHS: The larynx, or voice box, sits at the back of the throat, just above the windpipe. The vocal cords are elastic bands of tissue attached to the inside of the voice box; as air moves through the windpipe it is pushed through these cords. When the cords contract or relax, this alters the pitch of the sounds they produce. Excessiveness hoarseness, loss of voice, throat pain, or even a constant urge to clear one's throat can indicate a growth or abrasion on the voice box. Small lumps and bumps on the vocal cords can be caused by too much yelling (which may lead to ulcers) or exposure to cigarette smoke. Smoking can also lead to cancerous growths on the larynx.
WHAT ARE LASERS: "Laser" stands for Light Amplification by Stimulated Emission of Radiation. It describes any device that creates and amplifies a narrow, focused beam of light whose photons are all traveling in the same direction, rather than emitting every which way at once. Laser light contains only one specific color, or wavelength. Because every photon is traveling in the same direction, the light is tightly focused into a concentrated beam, unlike the light emitted from a flashlight, where the atoms release their photons randomly in all directions.
There are several different types of lasers. Solid-state lasers use crystals, such as ruby. Carbon dioxide lasers emit energy in the far-infrared and microwave regions of the spectrum. This type produces intense heat, and is capable of melting through objects. Conventional diode lasers are the type used in pocket laser pointers and CD and DVD players.
The Optical Society of America contributed to the information contained in the TV portion of this report.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.