Choosing Between Office-based and Operating Room Procedure for Pharynx-laryngeal Benign Lesions

PROGRAM DESCRIPTION: Thanks to the improvements in technology: flexible videoendoscopes with operating channels, disposable videoendoscopes, different fiber-guided laser wavelengths, injectable substances with different viscosities, narrow band imaging for better detections of dysplastic or cancerous lesions, office-based procedures are more and more popular. But we have to recognize that financial issues and easy access to the operating room are major factors in the decision.
But selection of patients is then paramount as well as the selection of lesions that can be properly treated in the office. The experience of the surgeon is another major factor.
Usually injection procedures can be performed in the office, provided that the patient will collaborate but the precision is not as good as in the OR with the patient under general anesthesia. If the injection must be very precise like for instance with injectable hydroxyapatite particles, an OR procedure should be chosen.
Superficial lesions like nodules, polyp, superficial thickening, granuloma can also be good indications but intracordal lesions are contraindication because the risk of secondary scar.
The volume of the lesion also matters . Procedures under local anesthesia are limited in time due to the tolerance of the patient and the limited efficiency of the anesthesia.
The risk of bleeding must also be evaluated . Wavelengths well absorbed by red chromophores must be favored like the KTP or the so called blue laser which is a diode laser. However in comparison with CO2 laser, the thermic effect in the surrounding tissues is more important , what will delay the healing with a major risk of producing a scar .
All the aspects will be discussed during the presentation to contribute to the decision between local and general anesthesia for each possible case.

OUTCOME OBJECTIVE 1: The participants will be informed about the recent technological developments for office-based and OR procedures.

OUTCOME OBJECTIVE 2: The participants will be able to understand to comparative advantages and disadvantages of office-based procedures and OR procedures.

OUTCOME OBJECTIVE 3: The participants should be able to decide what approach to recommend or perform for their own patients.

BACKGROUND STATEMENT: Office-based procedures are more and more popular among laryngologists of the reasons already discussed but according to what we can observe in Europe and probably also in the States, an overuse of the procedure should be prevented .

Comprehensive Otolaryngology Track Statement : If some specific procedure are usually performed by trained laryngologists , any ORL specialist should know what to recommend to his/her patient.
Indications of basic procedures like transnasal VS transoral videoendoscopies could be performed by comprehensive otolaryngologist.