Force Metrics and Suspension Times for Microlaryngoscopy Procedures

To determine the difference in force metrics measured by the laryngeal force sensor for various suspension microlaryngoscopy (SML) procedures and their perioperative narcotic requirements.

Prospective observational study.

Academic tertiary center.

The laryngeal force sensoris a force sensor designed for SML procedures. Prospectively enrolled patients had dynamic recordings of maximum force, average force, suspension time, and total impulse. Procedures were grouped into excision of striking zone lesions, nonstriking zone lesions, endoscopic cancer surgery with margin control, and airway dilation. Narcotic administration in the intraoperative period and postanesthesia care unit was also recorded and converted into IV morphine equivalents. Surgeons were blinded to the force recordings during surgery to prevent operator bias.

In total, 110 patients completed the study. There was no significant difference in average force across different procedures, however, a significant difference was seen for maximum force (P = 0.025), suspension time (P < 0.001), and total impulse (P = 0.002). The highest values were seen for endoscopic cancer surgeries with margin control with a mean maximum force of 49.4 lbf (95%CI, 37.1-61.7), mean suspension time of 60.2 minutes (95%CI, 40.5-79.9), and mean total impulse of 31.3 ton*s (95%CI, 15.2-47.3). A significant difference (P < 0.01) in perioperative narcotic requirements was also seen, with endoscopic cancer surgery cases having the highest requirements at 27.6 mg of ME (95%CI, 16.1-39.2 mg).

Significant differences in force metrics exist between various SML procedures. Endoscopic cancer surgery is associated with higher force metrics and perioperative narcotic requirements.