CO2 Laser in Otolaryngologic Surgery
While CO2 laser energy has been used in otolaryngology for almost 50 years, it has historically been limited to cumbersome line-of-sight systems with difficulty in obtaining sufficient anatomical access.
OmniGuide Surgical’s Enhanced Safety Fibers overcome these limitations by enabling the delivery of CO2 laser in an easy-to-use, flexible fiber. OmniGuide laser energy can be delivered through our custom instrumentation, which was designed specifically for head and neck surgeons, through a rigid bronchoscope, flexibible endoscope, or in conjunction with a robotic system.
|Monopolar cautery, from left to right, 35, 30 and 25 Malis. Insert shows specimen excised at 30 Malis.|
|H&E specimen of monopolar electrosurgery tongue lesion produced at 40 Malis. Total collateral damaged area is highlighted. Image analyzed at 4x magnification.|
OmniGuide CO2 Fiber
|Two adjacent cuts using the CO2 laser fiber at 15W, 70 PSI. Insert shows one of the specimens excised.|
|H&E specimen of CO2 laser fiber tongue lesion produced at 20W, 70 PSI. Total collateral damaged area is highlighted. Image analyzed at 10x magnification.|
Enhanced Surgical Precision
- Improved access near difficult-to-reach anatomy, contoured anatomy1,2
- Minimal thermal trauma improves confidence in obtaining negative margins3
Easier Histological Assessment4,5
- Smaller coagulation zone and width of injury makes it easier to assess resection margins
Fast Patient Recovery, Return to Normal Diet1
- Low degree of post-operative swelling and scarring3,4
- Good swallowing function and low need for tracheostomy, G-tubes4,6
CO2 Laser Clinical Applications
- Oral Cavity Resection
- Partial Glossectomy
- Retromolar Trigone
- Floor of Mouth
- Oropharyngeal Resection
- Tonsillar Cancer
- Base of Tongue
- Buccal Lesion
- Soft Palate
- Laryngeal Resection
- Partial Laryngectomy
- Cordectomy Zenker’s
- Nasopharyngeal Stenosis
- Tracheal Papilloma
- Tracheal Granuloma
- Tracheal Amyloid
- Vocal Cord Polyps/Cysts
- Subglottic Hemangioma
- Subglottic Stenosis Surgery
- Posterior Cricoid Split
CO2 Laser Papers & Publications
Peer-Reviewed Clinical Papers
- Shires CB et al. “Management of suprastomal tracheal fibroma: Introduction of a new technique and comparison with other techniques.” Int J Pediatr Otorhinolaryngol. 2009 Jan 73(1):67-72. – Suprastomal tracheal granuloma/fibroma (SSTGF) is a common cause of failure to decannulate following pediatric tracheostomy. A hollow core guide fiber for the CO(2) laser has been developed that can be advanced to better approximate targeted tissues and minimize thermal spread using a near-contact method.
- Moberly AC, Halum SL. Patient tolerance of the flexible CO2 laser versus the 585-nm pulsed-dye laser for office-based laryngeal surgery. COSM 2008 Presentation – Moberly AC, Halum SL. Patient tolerance of the flexible CO2 laser versus the 585-nm pulsed-dye laser for office-based laryngeal surgery. COSM 2008 Presentation.
- Jacobson AS et al. Emerging technology: Flexible CO2 laser WaveGuide, Otolaryngol–Head & Neck Surg. 2006;135:469-470 – Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA. firstname.lastname@example.org.
- Torres D et al. OmniGuide Photonic Bandgap Fibers for flexible Delivery of CO2 Laser Energy for Laryngeal and Airway Surgery. Proceedings of the SPIE,2005;5686:310-321 – The CO2 laser is the most widely used laser in laryngology, offering very precise cutting, predictable depth of penetration, and minimal collateral damage due to the efficient absorption of CO2 laser by water. Surgical applications of CO2 laser in microlaryngoscopy include removal of benign lesions and early-stage laryngeal cancer.
- Solares CA, Strome M. Transoral Robot-Assisted CO2 Laser Supraglottic Laryngectomy: Experimental and Clinical Data. Laryngoscope. 2007; 117:817–820 – Transoral CO2 laser surgery for selected supraglottic tumors results in improved postoperative function and decreased morbidity, with comparable survival to open surgery. Recently, robot-assisted techniques have been reported for the management of supraglottic lesions.
- Holsinger FC, Weber RS. Swing of the surgical pendulum: a return to surgery for treatment of head and neck cancer in the 21st century? Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S129-31 – Treatment for head and neck cancer has evolved significantly during the past 100 years. Beginning with Bilroth’s total laryngectomy on New Year’s Day in 1873, “radical” surgery remained the only accepted treatment for head and neck cancer when optimal local and regional control was the goal.
- Holsinger FC et al. Use of the Photonic Band Gap Fiber Assembly CO2 Laser System in Head and Neck Surgical Oncology. Laryngoscope. 2006 Jul;116(7):1288-90 – Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
- Devaiah A et al. Surgical Utility of a New Carbon Dioxide Laser Fiber: Functional and Histological Study, Laryngoscope. 2005; 115:1463–1468 – OBJECTIVES/HYPOTHESIS: The objective was to investigate the functional and histological properties of surgical procedures using a new carbon dioxide (CO2) laser fiber. STUDY DESIGN: In vitro and in vivo animal models.
- Zeitels SM et al. Carbon dioxide laser fiber for laryngeal cancer surgery, Ann Otol Rhinol Laryngol. 2006 Jul;115(7):535-41 – OBJECTIVES: The carbon dioxide laser has evolved to be the premier dissecting instrument for hemostatic cutting during endolaryngeal cancer resection. However, dissection is limited to mirror-reflected line-of-sight delivery of the laser.
- More than Smoke and Mirrors: Expanding Technology and Use of Lasers in Otolaryngology-Head and Neck Surgery. ENT Today. 2007; 2:4 – Long used in a number of medical specialties, lasers offer a minimally invasive way to treat a variety of benign and malignant conditions. Otolaryngology-head and neck surgery is one of the first areas of surgery to successfully employ a number of types of lasers for medical and cosmetic purposes.
- Hanby et al, World Journal of Surgical Oncology 2011, 9:83
- Holsinger et al, Laryngoscope 116: July 2006
- Solares and Strome, Laryngoscope 117: May 2007
- Gottschlich and Ambrosch, Operative Techniques in Otolaryngology (2004) 15, 252-255
- Zeitels et al, Annals of Otology, Rhinology & Laryngology 115(7):535-54
- Rich et al, Laryngoscope July 2009
VELOCITY High Performance Fiber
VELOCITY is OmniGuide Surgical's premier flexible fiber. VELOCITY offers the precision of CO2 laser with the cutting speed of monopolar electrosurgery. VELOCITY fibers incorporate 12 mirror layers, more than any other flexible fiber, resulting in a 50% output increase for greater speed and precision cutting than ever before. VELOCITY fibers are 200cm in length and deliver up to 30 Watts of energy.
ELEVATE ELITE ENT Fiber
ELEVATE ELITE ENT Fibers allow surgeons to operate with confidence near delicate anatomy by providing minimally invasive access, precise and predictable tissue interaction, and the micron-level thermal spread. ELEVATE ELITE ENT fibers are 180cm in length and deliver up to 20 Watts of energy.
BeamPath® Robotic Fiber
OmniGuide Surgical's BeamPath Robotic Fibers incorporate the same performance and safety features as our other proprietary fibers, but have been designed specifically for use in robotic surgery. The BeamPath Robotic Fiber is inserted into the flexible coil of the FlexGuide™ ULTRA, and works in tandem with a surgical robotic platform to delivery CO2 laser energy in a minimally invasive robotic approach.
ELEVATE ENT Handpieces
ELEVATE ENT handpieces have been specifically engineered for use in a variety of head and neck surgical procedures, and feature an ergonomically-inspired design that incorporates counterweight technology to reduce fatigue and improve surgeon comfort. A graduated cannula design aids in maintaining a clear visual field, while the enhanced bends assist in accessing hard to reach anatomy.
FlexGuide ULTRA instrumentation brings the precision of CO2 energy to robotic surgery. FlexGuide ULTRA is compatible with 5mm and 8mm large needle drivers1 - no additional robotic arm or instrumentation is needed. Its coiled design provides flexibility to accommodate full robotic wristed articulation. A 4mm spatula tip enables efficient blunt dissection and convenient estimation of distance from target tissue.
FMX Ferromagnetic Technology in Otolaryngologic Surgery
Domain Surgical’s FMX Ferromagnetic Surgical System uses ferromagnetic technology to precisely cut, coagulate, and seal tissue; with a fraction of tissue injury compared to other surgical technologies, and without passing electrical current through the patient. Because no electrical current passes through the patient, FMX surgical instruments can be used safely near nerves, vessels, and other delicate tissue structures in otolaryngology surgery.
- FMwand dissector produces a precise, surface-only thermal effect with tactile control and minimal tissue drag
- Clean dissection when using the FMwand results in superior visibility and clear margins for reliable pathology specimens
Minimized Thermal Injury
- FMwand produces as little as 1/10th the thermal injury compared to monopolar electrosurgery1,2
- FMwand imparts as few as 80 microns (0.08 mm) of thermal spread in some tissue types1,2
- FMsealer produces a pure thermal effect with less lateral thermal spread than competitive bipolar and ultrasonic devices1,4
Efficient and Robust Vessel Sealing
- FMsealer delivers reliable vessel sealing performance and burst pressure measurements comparable to or better than industry-leading bipolar devices1,4
- FMsealer delivers extremely fast and efficient sealing/dividing cycles through vascular tissue bundles, including in tough adhesions and scar tissue1,4
- No electrical current passes through tissue – no grounding pad is used, and no spark, arcing, or stray current, no stimulation of muscles or nerves
- Surgeons using FMX instruments report no interference with electrophysiological monitoring or cochlear implants1,3
FMX Clinical Applications
- Complex open neck dissections*
- Partial Glossectomy*
- Cochlear implant procedures*
* Based on surgeon experiences
- Internal data on file
- MacDonald, J.D., Bowers, C.A., Chin, S.S. et al. Comparison of the effects of surgical dissection devices on the rabbit liver. Surg Today (2014) 44: 1116. doi:10.1007/s00595-013-0712-4
- Weiss, J. Peter Manwaring, Preston et al. Freedom from electromagnetic interference between cardiac implantable electronic devices and the FMwand ferromagnetic surgical system. Journal of Clinical Anesthesia , Volume 25 , Issue 8 , 681 – 684
- Jenwood Chen, MD, Preston K. Manwaring, MSEE, PhD, Robert R. Scott, BSME, Kim H. Manwaring, MD, Robert E. Glasgow, MD. Ferromagnetic Heating for Vessel Sealing and Division – Utility and Comparative Study to Ultrasonic and Bipolar Technologies. Surgical Innovation, Volume: 22 issue: 4, page(s): 329-337
FMwand Hemostatic Dissector
FMwand hemostatic dissector is an intelligent thermal dissection device that precisely cuts and coagulates with a fraction of the tissue injury compared to monopolar electrosurgery, without passing any electrical current through the patient.
FMsealer Open Shears
FMsealer Open Shears are thermal vessel sealing instruments that use ferromagnetic technology to efficiently seal and divide tissue with minimal thermal injury to adjacent tissue. FMsealer Open Shears are indicated for sealing vascular tissue bundles and vessels up to and including 7 mm in diameter, including lymphatics, in open procedures.
Thulium Laser Technology in Otolaryngologic Surgery
For the excision of pharyngeal tumours and in tonsillectomy the RevoLix jr. laser reveals its outstanding ability for tissue cutting at excellent hemostasis. The necrotic seam underneath the visible cut is less than 1 mm.
Mucosa reduction and soft tissue coagulation in the nasal region by RevoLix jr. is entirely bloodless. Borderlines to the surrounding tissue are clean and the easily identified. Anatomic structures remain preserved. The necrotic seam is restricted to a minimum thus reducing post-op inflammation.
RevoLix jr. Laser
In soft tissue surgery efficient and even cutting combined with strong haemostasis is required. This is provided by the RevoLix jr. laser in an unmatched manner. The new RevoLix jr. laser operates in a continuous wave mode and cuts and vaporizes circulated and white tissue without deep penetration or uncontrolled necrosis
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