CO(2) laser endolaryngeal microsurgery with the deflect tip of the pipe-guide handpiece.

Some regions of the larynx such as the inferior surface of the vocal fold and the subglottis cannot be adequately irradiated with a conventional laser instrument and a microscopic manipulator coupled to an operating microscope. To improve on this disadvantage, we present a method for CO(2) laser endolaryngeal microsurgery with the deflect tip of the pipe-guide handpiece. After exposure of the larynx, a pipe-guide handpiece with a deflective tip is inserted into the laryngeal cavity, and the lesion is vaporized and removed via direct laryngoscope observation under the microscope. With the deflect tip of the CO(2) laser pipe-guide handpiece, the laser beam can be irradiated vertical to the laryngeal mucosa, especially in regions such as the inferior surface of the vocal fold and the subglottic mucosa. The mucosa can be adequately vaporized with this laser instrument. This technique allows the surgeon to perform a precise, more hemostatic endoscopic operation with decreased postoperative edema. Disadvantages of this surgical procedure are that surgeons cannot perform a hands-off operation through the narrow operation field of the microlaryngoscope.