What’s New

Request an Appointment

“Dropping Acid” Blog

Minimally Invasive Laryngeal & Throat Surgery

Office-based laryngeal surgery is safe, profoundly effective, and preferred by patients over traditional surgical methods.  In-office surgery has many advantages, including:  (1) no intravenous sedation or other medication is needed ; (2) patients require no postoperative recovery; (3) the only anesthesia needed is topical (spray) with a topical anesthetic; (4) biopsies can be obtained for histology; (5) the actual operating time is minimized (in most cases to under 30 minutes); (6) many procedures are actually technically easier in the office than in the operating room; (7) there are tremendous time and cost savings for the patient and the surgeon.

The great advance of in-office unsedated laser surgery is there is no risk of general anesthetic complications; it’s less invasive, there are no large rigid metal endoscopes and so there are fewer complications such as airway problems, dental injuries, or sore tongue.  Our safety record for treating vocal disorders withe the laser here at the Voice Institute of New York is 100% (i.e., no complications).

Koufman JA, Rees CJ, Frazier WD, Kilpatrick LA, Wright SC, Halum SL, Postma GN. Unsedated office-based laryngeal laser surgery: Review of 443 cases using three wavelengths. Otolaryngol Head Neck Surg 137:146-51, 2007.

This paper reports a series of Dr. Koufman’s patients who underwent unsedated (no anesthesia except topical spray) office-based laryngeal laser surgery using three different lasers: (1) the pulsed-dye laser (PDL), (2) the carbon-dioxide (CO2) laser, and (3) the thulium:YAG laser. That no anesthesia is needed means there are no anesthesia complications.   Indeed, there were no significant complications of any kind in any of the patients reported.

Today, this type of minimally invasive surgery is the way to go for patients with vocal cord polyps, papillomas, cysts nodules, granulomas, and early cancer. Patients tolerate the surgery well and can return to normal activity immediately after their procedures. In addition, in many cases the results are quite superior to more expensive, invasive and expensive laryngeal surgery. Incidentally, this is the largest series of patients ever reported in the medical literature.  Dr. Koufman pioneered this type of surgery and remains one of the world’s most experienced surgeons; she has now done over 1,000 such cases.  Click to see full article

Koufman JA. Introduction to office-based surgery in laryngology. Curr Opin Otolaryngol Head Neck Surg. 15:383-6, 2007.

This is a short review article that discusses the advantages and disadvantages of office-based throat and esophageal surgery. (There aren’t many disadvantages.) This paper also discuses some of the reasons that these outstanding technologies have not yet proliferated more widely, namely bureaucratic inertia among third-party and government payers and pro status quo (financial) conflicts of interests among some key healthcare providers.  Click to see full article

Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract. Otolaryngol Head Neck Surg. 134:1023-7, 2006.

This paper reports the perceptual experience of the authors’ patients undergoing 328 unsedated, in-office laryngeal laser surgeries. Patients were asked to rate their comfort from 1-10, with 10 being complete comfort. The average score was 7.4, and 87% of the study group said that they would prefer the in-office procedure again if another similar procedure were necessary.  Click to see full article

Rees CJ, Postma GN, Koufman JA. Cost savings of unsedated office-based laser surgery for laryngeal papillomas. Ann Otol Rhinol Laryngol 116:45-48, 2007.

The average cost savings of unsedated office-based laryngeal laser surgery for laryngeal papillomas is in excess of $7,000. It is amazing that the insurance companies don’t insist on this technique, because it is safe and well tolerated by patients as well as being less expensive. Click to see full article

Clyne SB, Halum SL, Koufman, JA, Postma GN.  Pulsed-dye laser (PDL) treatment of laryngeal granulomas. Ann Otol Rhinol Laryngol 114:198-201, 2005.

This is the first report of use of the PDL for the treatment of granulomas. Click to see full article

Postma GN, Cohen JT, Belafsky PC, Halum SL, Gupta SK, Bach KK, Koufman JA. Transnasal esophagoscopy revisited (over 700 consecutive cases). Laryngoscope 115:321-3, 2005.

Transnasal esophagoscopy (TNE) was introduced by Drs. Koufman and Aviv over a decade ago. This moderately large series reports the findings and the authors’ experience.  Click to see full article

Amin MR, Postma GN, Setzen M, Koufman JA. Transnasal esophagoscopy: A position statement from the American Broncho-Esophagological Association (ABEA). Otolaryngol Head Neck Surg 138:411-13, 2008.

The ABEA is one of the oldest and most prestigious specialty societies in the nation. It was founded by the grandfather of all endoscopy, Dr. Chevalier Jackson. Indeed, over a hundred years ago, Dr. Jackson invested the esophagoscope.

This article reviews and compares the advantages and disadvantages of traditional endoscopy and TNE. The ABEA concludes that TNE is an outstanding technology that is comparable to traditional endoscopy performed with anesthesia. Click to see full article