Treatment Strategy for Laryngeal Papillomas at Our Hospital - Focusing on Office-Based Surgery –

Abstract

Laryngeal papillomas are refractory tumors characterized by recurrence and multiple lesions secondary to human papillomavirus infection. While surgical treatment is the standard approach, many cases are difficult to manage and often require multiple operations. Complete resection using cold instruments with the conventional microflap technique under general anesthesia is fundamental. However, since carbon dioxide lasers were first used for laryngeal cancer treatment in the 1970s, laser surgery has gained prominence for laryngeal papillomas. In recent years, photocoagulation lasers (such as KTP lasers and green lasers) have been developed. This enables avoidance of inpatient surgery under general anesthesia, thereby reducing the physical, time, and financial burden on patients. However, the production of KTP laser devices in Japan ceased in 2008, making new purchases impossible. Recently, green lasers, originally developed for ophthalmic surgery and approved in Japan as medical laser devices, have been used. In comparison to KTP lasers, green lasers have a lower output. Green lasers exhibit excellent absorption by oxyhemoglobin in the blood vessels, providing superior hemostatic capability. Conversely, they absorb water poorly, resulting in inferior cutting and vaporization capabilities. Consequently, they offer the advantage of minimal invasion of the vocal fold mucosa and surrounding tissues, thereby reducing the likelihood of scar formation.
In October 2015, our hospital introduced outpatient laser photocoagulation surgery under local anesthesia using a green laser. Over the nine-year period from October 2015 to September 2024, we performed 151 photocoagulation laser procedures in 45 cases of laryngeal papilloma with vocal cord lesions.
We herein present our experience with photocoagulation laser surgery for laryngeal papillomas at our institution. We also examined our treatment strategy for these lesions and the impact of treatment on voice function and tumor control using the Derkay Score. Our findings suggest that EGLS is an effective treatment that combines “efficacy comparable to LMS” with “preservation and even improvement of the voice function.”