Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy
17 November 2017
21 April 2018
09 August 2018 (online)
Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools.
Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure.
Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015.
Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures.
Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.
- 1 Kawaiada M, Fukuda H, Kohno N. Multidirectional observations of the larynx using transurethral rigid endoscopes during direct laryngoscopy. J Laryngol Otol 2012; 112 (05) 464-466
- 2 Wambier H, Sonego TB, Batista FC, Kohler R. Lesões pré-malignas da laringe: revisão de literatura. Rev. Bras. Cir. Cabeça Pescoço. 2012; 41 (01) 42-47
- 3 Alarcon JB, Mesa A. Manual clínico da via aérea respiratória. São Paulo: Artes Medi; 2004
- 4 Pinar E, Calli C, Oncel S, Selek B, Tatar B. Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy. Eur Arch Otorhinolaryngol 2009; 266 (05) 699-703
- 5 Hsiung MW, Pai L, Kang BH, Wang BL, Wong CS, Wang HW. Clinical predictors of difficult laryngeal exposure. Laryngoscope 2004; 114 (02) 358-363
- 6 Kleinsasser O. Microlaryngoscopy and Endolaryngeal Microsurgery. 3rd Ed. Philadelphia: Hanley; 1991: 593-594
- 7 Andréa M, Dias O, Santos A. Contact endoscopy during microlaryngeal surgery: a new technique for endoscopic examination of the larynx. Ann Otol Rhinol Laryngol 1995; 104 (05) 333-339
- 8 D'avila JS, Sennes LU, Tsuji DH. Estudo comparativo da microvascularização das cordas vocais humanas acometidas por cisto e reação nodular contra-lateral, “in vivo”, através das endoscopias rígidas e de contato da laringe. Rev Bras Otorrinolaringol 2003; 69 (02) 166-173
- 9 Andréa M, Dias O. Rigid and contact endoscopy in microlaryngeal surgery: technique and atlas of clinical cases. Philadephia: Lippincott-Raven; 1995: 1-110
- 10 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39 (11) 1105-1111
- 11 Ballin AC, Dacheux E, Filho DM. , et al. Avaliação Sistematizada da Dificuldade de Exposição das Pregas Vocais na Microcirurgia da Laringe Difficulty Systematized Evaluation of Vocal Folds Exposure in Microsurgery of the Larynx. Arq Int Otorrinolaringol 2010; 14 (03) 294-301
- 12 Friedrich G, Kiesler K, Gugatschka M. Curved rigid laryngoscope: missing link between direct suspension laryngoscopy and indirect techniques?. Eur Arch Otorhinolaryngol 2009; 266 (10) 1583-1588
- 13 Xidong C, Xia Z, Chenjie X, Wenhong Y, Huichang Y, Jiaqi J. Management of difficult suspension laryngoscopy using a GlideScope® Video Laryngoscope. Acta Otolaryngol 2012; 132 (12) 1318-1323