Scanning Super/Ultrapulsed CO2 Laser Efficacy in Laryngeal Malignant Lesions.

Introduction: The authors review their experience in transoral laryngeal microsurgery (TLM) that they performed with two different CO2 laser devices from the same company, which were both equipped with a micromanipulator and digital scanner. Material and Methods: A total of 91 glottic and glotto-supraglottic cancers were treated during the years 2009-2016 and then analyzed in relation to the laser performances and the long-term oncologic results. Results: Laser devices proved to be very efficient and the UP mode was confirmed to be the best in terms of cutting precision and lowest thermal damage. Conclusions: CO2 laser TLM is the preferred option for the majority of small-medium size glottic and supraglottic cancers and may also be used for bigger tumors, especially in older patients.

Application of a Scanner-Assisted Carbon Dioxide Laser System for Neurosurgery.

BACKGROUND: Despite potential advantages, broad carbon dioxide (CO2) laser diffusion in neurosurgery was historically prevented by several operative limitations. Nonetheless, in recent decades, significant improvements, in particular the development of surgical scanners, have made CO2 laser surgery easier and reproducible. The aim of this study was to report our preliminary experience with the SmartXide2 CO2 laser system. METHODS: The SmartXide2 laser system is a CO2 laser with a radiofrequency-excited laser source, a surgical scanner, and a high-precision micromanipulator, which are connected to the surgical microscope. Ten different brain and spinal tumors were treated to evaluate the laser system potential in different neurosurgical scenarios. Four illustrative cases were presented. RESULTS: The CO2 laser was used together with the traditional instruments in every step of the procedures, from the initial pial incision (intra-axial tumors) or early debulking (extra-axial lesions), to progressive tumor removal, and, lastly, for surgical cavity hemostasis. No injury to the surrounding neurovascular structures was observed. Postoperative neuroimaging confirmed complete tumor removal and showed a marked reduction of preoperative surrounding edema without signs of cerebral/medullary contusions. CONCLUSIONS: In selected cases, the SmartXide2 CO2 laser system could be a helpful, reliable, and safe surgical instrument to treat different cerebral and spinal lesions. It addresses some of the limitations of laser systems and is able to cut/ablate and coagulate the tissue simultaneously, with minimal lateral thermal spread, preserving the surrounding eloquent neurovascular structures. Moreover, having no consumable accessories, it is also cost-effective.

Characterization and Ex Vivo Application of Indocyanine Green Chitosan Patches in Dura Mater Laser Bonding.

Dura mater repair represents a final and crucial step in neurosurgery: an inadequate dural reconstruction determines dreadful consequences that significantly increase morbidity and mortality rates. Different dural substitutes have been used with suboptimal results. To overcome this issue, in previous studies, we proposed a laser-based approach to the bonding of porcine dura mater, evidencing the feasibility of the laser-assisted procedure. In this work, we present the optimization of this approach in ex vivo experiments performed on porcine dura mater. An 810-nm continuous-wave AlGaAs (Aluminium Gallium Arsenide) diode laser was used for welding Indocyanine Green-loaded patches (ICG patches) to the dura. The ICG-loaded patches were fabricated using chitosan, a resistant, pliable and stable in the physiological environment biopolymer; moreover, their absorption peak was very close to the laser emission wavelength. Histology, thermal imaging and leak pressure tests were used to evaluate the bonding effect. We demonstrated that the application of 3 watts (W), pulsed mode (Ton 30 ms, Toff 3.5 ms) laser light induces optimal welding of the ICG patch to the dura mater, ensuring an average fluid leakage pressure of 216 ± 105 mmHg, falling within the range of physiological parameters. This study demonstrated that the thermal effect is limited and spatially confined and that the laser bonding procedure can be used to close the dura mater. Our results showed the effectiveness of this approach and encourage further experiments in in vivo models.

Close and positive margins in non-melanoma skin malignancies of the head and neck. What to do in patients over 75 years of age? A preliminary study.

BACKGROUND: The incidence of non-melanoma skin cancer (NMSC) of the head and neck is increasing among older adults where it is credited to have a poorer prognosis also because the radicality of the surgery is often missed for a too conservative approach. An assessment of the amount of tumor regrowth and its prognostic consequences, in patients with surgical margins close or involved and older than 75 years, seems thus worth to be pursued in order to provide the best therapeutic strategy. METHODS: 91 cases of basal cell carcinomas (BBC) and squamous cell carcinomas (SCC), in patients older than 75 years of age, were followed from a minimum of one year to up to ten years. 15 patients had close margins at histology while 30 patients turned out to have positive margins. The other 46 patients had clear histologic margins and were considered as a control group. Several parameters were also considered like the site of occurrence, morphology, grading, size, thickness, type of margin involved (lateral, deep or both) and the status of the neck, for the SCC. A cut-off follow-up of two years (less than two years and more than two years) was adopted. RESULTS: Among the BCCs there was one recurrence in the clear margin subgroup (1/23-4.3%) and two in the positive margin subgroup (2/20-10%). For the SCCs there was only one recurrence in the group of positive margins (1/10-10%). Hence the observed rate of recurrence was much lower than reported in the literature. CONCLUSIONS: In the authors' opinion the low tendency to recur that NMSC shows in people older than 75 years might validate, at least in this age group, an "economic" surgical approach and a watchful attitude. Larger numbers are needed to assess and possibly validate this strategy, especially for the SCCs.

The normal-weight snorer: polysomnographic study and correlation with upper airway morphological alterations.

Obesity is recognized as playing an important role in causing snoring and in turning simple snoring into obstructive sleep apnea syndrome (OSAS). From our series of patients with sleep disturbances, we studied a group of 43 normal-weight snorers in whom we detected a significant number of OSAS episodes. An articulated diagnostic protocol was adopted, and Müller's maneuver was extensively applied. The resulting data were compared to data from a group of 43 obese patients from the same series. The major risk factor for developing OSAS in normal-weight snorers appears to be anatomic abnormalities, in particular, septal deviation and base of tongue hypertrophy. Soft palate hypertrophy alone is not enough, although in obese snorers it can produce a sleep disorder. The normal-weight snorer needs to be thoroughly investigated because of the significant risk of developing OSAS and for the detection of multiple concomitant sites of obstruction.

Surgery of the nasal columella in external valve collapse.

The authors describe and discuss their experience with the collapse of the external nasal valve, focusing on the role that surgery of the columella plays in solving this problem. Thirty-seven cases were treated. In all but I there had been a previous septorhinoplasty. Seven patients had concomitant internal valve collapse. A modified alarplasty associated with columelloplasty was adopted in the cases with severe collapse. When the reduction of the nostril opening was mild to moderate, the surgical strategy varied depending on the width of the columella base: alarplasty in cases with a narrow to normal columella, and columelloplasty in the presence of a wide columella base. The authors' philosophy tends to minimize intervention on the nasal valve areas. Their results demonstrate that when the collapse and its functional effect are not too severe, a good result can be achieved by working only on the columella, especially if its base is significantly wide.