Monday, Aug. 06, 1973
Laser Scalpel
Surgery to remove growths on vocal cords is usually difficult for doctor and patient alike. The surgeon must work in a severely constricted area, use unwieldy instruments up to a foot long, and exercise extreme caution for fear of removing or damaging healthy--and irreplaceable--vocal tissue. The patient, who must usually endure considerable post-operative pain, often has to forgo even the satisfaction of complaining; any talking may irritate his throat and delay his recovery. Now doctors at Boston University Medical Center are finding a way around both problems. They have found that a carbon-dioxide laser, which produces a high-intensity beam of invisible infra-red light, can quickly remove many polyps, cysts and cancers from vocal cords. Moreover, the laser operations, which are more precise and efficient than conventional surgery or freezing with cryoprobes, have proved remarkably free of discomfort for the patient.
Super-powerful laser beams have been used for more than a decade by eye surgeons to repair detached retinas. More recently, lasers have also been used to destroy certain skin cancers. But the Boston group is the first to use a laser for vocal-cord surgery. Dr. Geza J. Jako of B.U.'s otolaryngology department began using the device--developed in cooperation with American Optical Co. Research Laboratories--on dogs in 1967; Dr. M. Stuart Strong, head of the department, pioneered its use on humans two years ago.
Brief Exposure. Though the laser is a complex mechanism, its application is relatively simple. Inserting a tube that gives them line-of-sight access to the vocal cords, the surgeons aim the laser through the passage by means of a binocular microscope and a tiny beam of normal white light. After zeroing in on the target growth, the surgeon then steps on a foot pedal that opens a shutter on the laser and allows the infra-red laser beam to strike the diseased tissue for as little as one-tenth or as much as one-half of a second. In several "shots," the powerful laser beam literally vaporizes the tissue on which it is focused, at the same time cauterizing nearby blood vessels so that there is no bleeding. It is so accurate that healthy neighboring tissue is not damaged.
The B.U. team, which has used the laser on more than 100 patients in the past 18 months, cautions that it is still too early to determine whether the growths removed will recur. But they are encouraged by their results to date, and so are their patients. Most patients who undergo laser surgery can eat, drink and talk (although only in a whisper) shortly after the anesthetic wears off. All leave the hospital the next day.
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