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Building on our pioneering development, since 1983, of office-based surgery on the laryngopharynx, Bastian Voice Institute utilizes two types of lasers in its videoendoscopy procedure room capabilities.

With the thulium laser, tissue effects are similar to those of the CO2 laser—except that laser energy is delivered via a glass fiber, passed through the channel of a flexible video-endoscope. We use the thulium laser primarily in the treatment of papillomas, granulomas that need a “stalk” divided, and clearly benign leukoplakia.

Also for office-based surgery is the pulsed-KTP laser. Laser energy is likewise delivered via a glass fiber, but the chromophore is not the water molecule, but instead the hemoglobin molecule, which makes this laser well-suited to treating vascular lesions, including capillary ectasia, lower-bulk papillomas, sessile granulomata, and pre-cancerous lesions or early, superficial carcinomas.

“Office-based” surgery is not appropriate for all lesions: e.g. those seen in singers with otherwise-irreversible lesions, or for cysts and glottic sulci or when large cancers are to be removed via laser excision. When appropriate, however, an advantage of videoendoscopy procedure room laser surgery is that patients can drive themselves to and from the procedure, saving both time and expense. In addition, certain tracheal lesions are more easily accessed through this approach, and persons with anatomical or medical issues that prohibit general anesthesia may be more safely and effectively managed.

First, some history. In the 1800s, surgery in the larynx was accomplished with the patient sitting in a chair and the surgeon reaching over the back of the tongue and down into the larynx with curved instruments. Initially this had to be performed without the assistance of even topical anesthesia! Subsequently, topical anesthetics were developed, making this kind of procedure much easier.

With the development of modern techniques of general anesthesia and endoscopes with tiny light bulbs and later fiberoptic light sources at their tips, upright, “chair” surgery became less and less common. By the 1970s, it had largely become a lost art.

By the early 1980s, excellent optical endoscopes, video technology, topical anesthesia, and short-acting sedatives made “chair surgery” once again logical. In the United States, Dr. Bastian helped to pioneer the reintroduction of office-based surgery via his teaching at Loyola University of Chicago, training of fellows, visiting professorships here and abroad, teaching at the American Academy of Otolaryngology, and his publications. Today, these approaches have become much more common, and they remain a specialty of Bastian Voice Institute physicians.

The advantage of office-based surgery is that the procedure – whether biopsy, injection, laser surgery, or otherwise – is performed in an awake though sometimes sedated patient whose throat is “numb.” Unsedated patients can drive themselves home afterwards. The clinical processes of both diagnosis and treatment are noticeably sped up, and of course the approach is highly cost-effective. This methodology is particularly advantageous in individuals whose anatomy makes operating room direct laryngoscopy difficult or whose medical condition is poor, increasing the risk of general anesthesia. The majority of patients find this approach very tolerable, and Drs. Bastian, Richardson and Hoesli have performed many hundreds of biopsies, injections, and other procedures using this tactic.

To our knowledge, Bastian Voice Institute was the second facility in the U.S. to have a RevoLix (LisaLaser) device available in the office setting. Particularly advantageous for minimal/recurrent disease, this laser can be used on selected lesions in the videoendoscopy procedure room of BVI’s facilities with the patient awake and topically “numbed,” rather than in the operating room.