Indirect larynx and pharynx surgery: a replacement for direct laryngoscopy

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Videoendoscopy

Background:

• Traditional direct laryngoscopy often requires general anesthesia and hospitalization.
• Indirect laryngopharyngeal surgeries encompass procedures like cancer staging, biopsies, vocal fold injections, and granuloma removal.
• Outpatient procedures under topical anesthesia offer potential benefits in terms of cost and patient convenience.

Purpose of the Study:

• To evaluate the efficacy and safety of indirect laryngopharyngeal surgeries performed in an outpatient videoendoscopy setting.
• To compare the indirect approach with traditional direct laryngoscopy in terms of outcomes, safety, and cost-effectiveness.

Main Methods:

• A retrospective chart review of 192 indirect laryngopharyngeal surgeries conducted over a 2-year period.
• Procedures were performed in an outpatient videoendoscopy laboratory under topical anesthesia, with or without intravenous conscious sedation.
• Techniques included cancer staging, biopsy, vocal fold injections (Teflon, Gelfoam, botulinum toxin, steroids), glottic web lysis, and granuloma removal.

Main Results:

• Successful completion rate of 96% for indirect laryngopharyngeal surgeries.
• Intravenous conscious sedation was used in 39% of patients.
• No significant complications were reported, indicating a high safety profile.

Conclusions:

• Indirect laryngopharyngeal surgery via outpatient videoendoscopy is a safe, effective, and convenient alternative to direct laryngoscopy.
• This approach avoids the need for operating rooms, hospitalization, and general anesthesia, offering significant cost-effectiveness.
• The indirect method should be reconsidered as the preferred approach for specific laryngopharyngeal clinical scenarios.