Office-Based Transoral Videoendoscopic Laryngeal Surgery Under Surface Anesthesia Performed by a Single Surgeon

Abstract

Surgery and biopsy for laryngeal and hypopharyngeal lesions under surface anesthesia using a flexible endoscope inserted nasally and transoral instruments such as a forceps are minimally invasive procedures that can be performed on an outpatient basis. Based on my experience, these procedures can be performed either by two medical professionals –a surgeon and a scopist– or by a surgeon working alone. This study focused on the key techniques required in procedures performed by a surgeon alone.

Between January 2015 and December 2023, 208 patients underwent these procedures under surface anesthesia, with 136 procedures performed by a single surgeon and 72 performed by two professionals (specifically, a surgeon and a scopist). The primary treatment options were laryngeal and hypopharyngeal diseases, including tumors, unilateral vocal cord paralysis, vocal cord atrophy, vocal cord polyps, and laryngeal granulomas. These procedures included vocal cord injections, mass resections, biopsies, cystotomies, stent removal, and laser vaporization.

The success rates were 95.6% for procedures performed by a single surgeon and 98.6% for those performed two professionals. Complications were minimal, with one case each of mild laryngeal edema and vasovagal reflex. Overall, this surgical method has been proven to be both effective and safe.