Monopolar cautery demonstrated a significantly higher degree of thermal damage compared to the harmonic scalpel or the CO2 laser.13

The authors recommended that pathologists be apprised of the surgical device type in order to adjust appropriately expectations of margin alteration. If technical limitations can be overcome, TLM confers several hypothetical advantages. Magnification and improved visualization can combine with piecemeal removal to map the tumor more accurately, reducing both the amount of normal tissue resected, and more closely Inhibitors,research,lifescience,medical following specific areas which are more infiltrative. In some ways, this resembles the approach used in Mohs resections of skin lesions. Figure 1. Sixty-six-year-old Female with a History of Laryngeal Inhibitors,research,lifescience,medical Carcinoma Treated with EBRT and Chemotherapy Presents with Recurrent Laryngeal Cancer. Because the approach for TLM is endoscopic, and the skin and subcutaneous fascial envelopes are not violated, the risk of tissue breakdown and fistulization is lower. This can result in decreased utilization of pedicled or free flap reconstruction for advanced-stage tumors requiring extensive mucosal resection. It is unclear how much this particular advantage of TLM is lost when unilateral Inhibitors,research,lifescience,medical or bilateral neck dissections are required.

Canis et al. described the utilization of TLM for the removal of T4a tumors in 2013.7 As described by other authors, tumors were resected in multiple Inhibitors,research,lifescience,medical blocks, with margins ranging from 2–3 mm in the glottis to 5–10 mm in the supraglottis and intra-operative frozen sections being used to ascertain margin status. The operating time ranged from 2 h to 5 h depending on the extent of the tumor and the experience of the surgeon. This report suggests

that there are very few technical limitations to TLM that cannot be overcome. Whether this experience is broadly applicable and, more importantly, teachable remains Inhibitors,research,lifescience,medical to be seen. CLINICAL selleck compound outcomes FOR TLM Early Laryngeal Cancers Transoral laser microsurgery (TLM) represents an important tool in the management of laryngeal tumors and is commonly utilized in the treatment of early-stage disease. One current point of debate among physicians treating laryngeal tumors is whether Bay 11-7085 TLM can offer similar clinical outcomes compared to organ preservation treatment consisting of external beam radiation therapy (EBRT).14–18 Feng et al. conducted a large meta-analysis comparing outcomes and costs associated with treatment of T1–T2 glottic cancers in 2011.16 Their analysis included 11 studies and 1,135 patients and demonstrated no significant difference in cure rates between TLM and EBRT. They were not able to conduct a substantial analysis of functional outcomes primarily because most studies to date fail to record functional outcomes using validated and reproducible scales, and only very rarely include long-term functional outcomes (see below). More recently, Lee et al.