Current practice and feasibility in microlaryngeal surgery: microsurgical pressing excision technique

Area of Science:

• Otolaryngology
• Microsurgery
• Laryngeal Surgery

Background:

• Conventional microsurgical techniques for benign vocal fold lesions include incision, dissection, bimanual retraction, microflap, and CO2 laser.
• Few novel microsurgical methods have emerged for treating these lesions.

Purpose of the Study:

• Introduce an innovative microsurgical method for precise removal of benign sessile vocal fold lesions.
• Ensure preservation of the intermediate and deep layers of the lamina propria during excision.

Main Methods:

• Utilized a microsurgical pressing excision technique (MPET) with custom-made, horizontally opening curved microscissors and microforceps.
• Employed a press-evert-cut approach using one instrument at a time for lesion removal.

Main Results:

• MPET was applied to 553 cases, with 520 (94%) patients achieving satisfactory/normal voice (G0) at 2 months postoperatively.
• No patient experienced a worsening of voice quality after the procedure.

Conclusions:

• MPET offers advantages including maximized exposure, precise excision in a horizontal plane, and controlled force adjustment.
• The technique is particularly beneficial for sessile vocal nodules, epithelial hyperplasia, and leukoplakia, especially in cases with challenging endolaryngeal exposure.
• MPET represents a well-tolerated and precise microsurgical option for specific benign vocal fold lesions.