Modern surgery requires minimally-invasive techniques, short hospital stays, lower morbidity and better quality of life for patients.

Over the last decades, thanks to rapid developments in technology resulting in new surgical techniques, we have experienced an impressive change in the way we manage patients. In this context, laser-assisted surgery (transoral laser microsurgery – TLM) is perhaps the best example in the field of head and neck surgery.    

The old, classical surgical techniques that sacrificed without real need large parts of healthy tissue, resulting in high morbidity, long hospital stays and sometimes even distortion of the patients’ picture, have now been abandoned in the western world and replaced by modern techniques such as the one mentioned above.

However, application of this modern surgical technique demands modern and usually costly equipment, specialised staff and mainly fully trained and experienced surgeons, whose knowledge has been gained with patience in centres abroad and experience acquired after attending to a large number of cases.

Dimitrios Pantazis – Prof.Dr.Wolfgang Steiner

Firmly believing that Greek patients should also enjoy the benefits of this surgical technique without having to resort to centres abroad, we have established the ENT laser microsurgery centre, being fully confident that this is on par with any similar centre abroad, providing the capacity to carry out any operation indicated by this technique and promising excellent results. Our aim is optimal results for the patient no matter the effort and time on our part.

We should note at this point that there is no other centre like that in our country. We would like to believe that our centres will provide solutions that no other can provide to difficult problems. We aspire that this centre will remain of the same calibre as similar ones abroad; all our human resources are working to this end with great love for the patient!

Oncology – laryngeal cancer

Out primary aim is to save the organ and treat the patient.

A1 Early vocal fold carcinomas

When we say early laryngeal carcinomas we mean vocal fold carcinomas and in particular stage T1 and T2 carcinomas that mainly manifest as hoarseness. These can be dealt with in two ways: 1) laser microsurgery; and 2) radiotherapy. Classical surgery involving tracheotomy and external incisions has been abandoned in the western world. Superiority of laser microsurgery is evident by far when compared to radiotherapy, as can be seen in the following table:

Advantages of TLM over radiotherapy

A2 Supraglottic laryngeal carcinomas

These make up approximately 40% of laryngeal carcinomas and they are more aggressive against the vocal cords. In these cases too, laser microsurgery has exceptional advantages over classical surgery (which has also been abandoned in most sites) and radiotherapy.

Post-operative radiotherapy is often not needed if the primary cancer has been fully resected and the preventive lymph node clearance is free of disease.

Advantages of TLM

• Transoral removal of tumour
• No tracheotomy
• Painless course
• Hospital stay from one to four weeks
• Exceptional oncological outcome
• Many times radiotherapy will not be needed.

A3 Advanced laryngeal carcinomas

Advanced laryngeal carcinomas require joint efforts by radiotherapy experts, oncologists and chemotherapy experts. However, with the radical resection of the tumour using Co2 laser and proper management of the lymph node, we can preserve the voice box to a considerable degree. Also, should the radiotherapy fail, the larynx can also be saved at approximately 70% of cases.

Total laryngectomy if unavoidable can be performed in our department always successfully. Finally, a special type of laryngeal carcinomas, verrucous carcinomas, can be treated with zero relapse rate.

Advantages of TLM

• No tracheotomy required except in rare cases.
• Tumour resection is controlled at a microscopic level removing only the absolutely essential quantity of healthy tissue.
• There are of course contra-indications albeit few and not worth going into detail here. In the vast majority of patients complete resection is feasible maintaining at the same time the functionality of the voice box. In many cases of supraglottic carcinomas after a preventive functional lymph node clearance that turns negative no post-operative radiotherapy is required and this is a huge benefit for the patient. Oncological planning does not change, which means the removal of lymph nodes when needed will be performed normally, as will post-operative radio- or chemotherapy.

The complete resection of the primary lesion is of paramount importance, as is lymph node management, for the overall course of the patient. Finally, a considerable number of carcinomas that were not successfully treated with radiotherapy can be treated with laser.

B Throat and oral cavity cancer

Management of amenable tumours of this kind using CO2 laser has many advantages to offer to the patient.

No external incisions are made, no deformation; transoral, painless, no blood loss, shorter hospital stay, same oncological results.

• Floor of mouth cancer
• Tongue cancer
• Tongue root cancer
• Tonsil cancer
• Hypopharyngeal cancer

Many times these operations can be performed without tracheotomy, a deplorable operation for the patient.

C Zenker’s diverticulum

Transoral endoscopic laser repair without external incisions and nasogastric intubation but with short hospital stay in most cases.

D Bilateral paralysis of the vocal folds

This is mainly a complication of total thyroidectomy mostly manifesting as severe and life-threatening dyspnoea.

Our experience managing this condition by CO2 laser is extensive, yielding exceptional results regarding both breathing and voice.

The operation is painless and the patient stays in the hospital for 2-3 days without tracheotomy or other external incisions.

E Benign conditions

Laser microsurgery has considerable advantages over conventional methods also regarding benign conditions, offering very short hospital stays, painless course of recovery without relapses.

Such conditions include:

• Laryngeal papillomas (after radical resection relapse is seen rarely in adults)
• Laryngeal cysts
• Laryngocoeles
• Laryngeal polyps
• Precancerous conditions e.g. leukoplakia (can be radically resected)
• Vocal cord adhesions etc
• Laryngeal-hypopharyngeal haemangiomas
• Tonsil hypertrophy
• Subglottic stenoses (idiopathic – Wegener’s etc) etc

F Ear surgery

In our centre, stapedotomy for the treatment of otosclerosis is performed using CO2 Laser. This surgical method provides absolute safety when removing the stapes super-structure and removing the plaque, minimising the complications that may cause to the patient to persistent vertigo or even hearing loss.

Moreover, when it comes to otosclerosis this is the only safe technique that does not entail a risk of hearing loss, which in the alternative of using conventional techniques, is very high.

Prerequisites of TLM

• Excellent equipment
• Excellent knowledge and experience on the part of the staff
• Excellent exposure of the surgical field
• Excellent cooperation with the pathologist
• Excellently organised department in general

G Head and Neck surgery

In our centre, apart from cases requiring laser microsurgery, a series of other operations are handled, such as:

• Parotidectomy
• Lateropharyngeal tumors
• Removal of submandibular gland
• Congenital cysts, such as thyroglossal duct cyst, broncheal cyst, lymphangioma
• Nasal septum
• Tonsillectomy – adenoidectomy
• Ear surgery such as for chronic otitis, tympanoplasty, otitis with discharge, etc
• Total thyroidectomy under neural monitoring
• Lymph node clearance of the neck (FND-RND)
• Myocutaneous flaps (repair of tissue deficits)