ENT LASER MICROSURGERY UNIT CLINIC OF ATHENS bio_admin
ENT LASER MICROSURGERY UNIT
Scientific Manager: Dimitrios Pantazis, Head and neck surgeon
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
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 root 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)
Precancerous conditions e.g. leukoplakia (can be radically resected)
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 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:
Removal of submandibular gland
Congenital cysts, such as thyroglossal duct cyst, broncheal cyst, lymphangioma
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)
Laryngeal cancer is fully manageable with high survival rates and preservation of the organ structure. For this to be true, there are the following prerequisites: prevention guided by proper information, knowledge of risk factors, preventive screening of high-risk patients, early diagnosis and management by specialised surgeons in specialised and well-organised sites.
Furthermore, as described above, laser microsurgery has many applications on many diseases apart from cancers.
The Bioclinic, always having a patient-centred philosophy and striving for the provision of top-quality health services, has established a special centre for ENT laser microsurgery, equipped and organised according to top standards.
Use of this equipment by specially trained and experienced surgeons who have in their record many successful operations guarantees the best outcome for the patient that suffers from laryngeal cancer or any of the above-mentioned conditions where laser microsurgery is indicated.