Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors.

We present a series of patients treated by transoral robotic surgery (TORS) using a new CO(2) laser wave guide (CO(2) LWG) (Lumenis, Santa Clara, CA). Patients older than 18 years, with malignant pharyngo-laryngeal tumors were enrolled in this prospective study after signing an informed consent. Four patients were enrolled in the study. The mean age was 56 years. One patient had a T1 base of tongue tumor, two patients had supraglottic tumors (T1, T2), and one had a T1 palatine tonsil tumor. All the procedures could be performed using a Maryland forceps, a 0° endoscope and a CO(2) LWG introduced via the robotic arm introducer. The laser parameters were: superpulse or continuous mode, 7-15 W, continuous delivery. The average set-up time was 30 min. The average surgical time was 94 min. No complications were noted due to the intraoperative use of the robot or the CO(2) LWG. One laser fiber was used for each of the surgeries. The mean coagulation depth was 200 μm (range 100-300). The mean hospital stay was 6 days. The CO(2) LWG is a reliable tool for TORS. It allowed more than 1 h of work without any trouble.