Radiofrequency ablation (coblation): a promising new technique for laryngeal papillomata

Possibilities of coblation in otorhinolaryngology: analytical review

OBJECTIVE

Review literature data on the coblation method in otorhinolaryngology.

MATERIALS AND METHODS

All materials from our study are published in peer-reviewed journals. The review is PubMed generated. In our clinic, 20 patients with bilateral paralytic laryngeal stenosis underwent cold-plasma posterior arytenoidcordotomy with Coblator II.

RESULTS

The analysis of the high-energy techniques currently applied in otorhinolaryngology shows the benefits of coblation due to the effect of lower temperatures on tissues. Patients subjectively reported improved breathing on day 10 with a closed coblation tracheostoma; after 3-6 months everyone underwent successful decannulation with plastic surgery of the cutaneous-tracheal fistula. Lately, the operated vocal fold was in the abduction position and the lumen of the glottis in the posterior third was 7-8 mm. Compensation of vocal function in the long-term postoperative period was achieved by patients due to long-term orthophonic training and the development of a vestibuloscapular phonation mechanism.

CONCLUSION

The advantages of coblation are mainly minimal trauma to the surrounding tissues, convenient resection, the ability to perform complete hemostasis at one time, and easier postoperative period for the patient.

Low-temperature radiofrequency coblation reduces treatment interval and post-operative pain of laryngotracheal recurrent respiratory papillomatosis

Laryngeal papillomatosis is a benign disease in the larynx but with the potential to develop into significant complications as a result of its high recurrence rate. CO₂ laser and radiofrequency controlled ablation (coblation) have been used to treat recurrent respiratory papillomatosis, but detailed comparisons of their respective treatment outcomes are not fully investigated. This retrospective study examines the procedure time, time interval between interventions, blood loss during operation, post-operative complications and pain scores among patients who received either CO₂ laser or radiofrequency coblation interventions for laryngotracheal recurrent respiratory papillomatosis. Compared with CO₂ laser intervention, radiofrequency coblation significantly reduced operation time, time interval between interventions, blood loss during operation and number of times bipolar electrocoagulation needed in each procedure. Post-operatively, pain scores after radiofrequency coblation were significantly lower than those after CO₂ laser intervention. Incidence rates of post-operative complications, in terms of palate pharyngeal mucosa damage, bleeding and subcutaneous emphysema, were also significantly reduced after radiofrequency coblation. Low-temperature radiofrequency coblation is a superior intervention compared with CO₂ laser against laryngotracheal recurrent respiratory papillomatosis.

[Treatment outcomes of recurrent respiratory papillomatosis : Retrospective analysis of juvenile and adult cases. German version]

BACKGROUND

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology which is characterized by multiple, recurrent growth of papillomas in the aerodigestive tract.

MATERIALS AND METHODS

The surgical outcomes and the recurrence rates of 106 patients with RRP of the larynx were analyzed. The patients were treated at the University of Magdeburg between 1983 and 2014. The surgical outcomes of conventional and laser surgery regarding time to relapse and complications were compared. In addition, the influence of the quadrivalent vaccine Gardasil® on the disease was analyzed in 10 patients.

RESULTS

Children with RRP had a statistically significant greater number of surgeries throughout their lifetimes compared to adult patients. There were no differences between the adult (n = 79) and juvenile (n = 27) groups in the time to relapse and the number of surgeries/year. The time to relapse and number of procedures/year were not influenced by the various surgical methods. Complications after conventional and laser surgery were not statistically different between the two groups. Serious complications and the need for a tracheotomy were only reported after conventional surgery. In the 10 patients who were immunized with Gardasil®, a statistically significant lower number of surgeries/year after vaccination was achieved.

CONCLUSION

RRP is a rare disease. Treatment requires experience and may be very difficult. The analysis of the course of the disease has shown that the treatment of choice is surgical excision with the CO₂ laser combined with the quadrivalent or polyvalent vaccine. Consequent vaccination of both boys and girls has the potential to reduce the occurrence of RRP.

Carbon Dioxide Laser Microsurgery versus Low-Temperature Plasma Radiofrequency Ablation for T1a Glottic Cancer: A Single-Blind Randomized Clinical Trial

Background

Very few studies have been conducted to compare carbon dioxide laser microsurgery (CO2-LS) with low-temperature plasma radiofrequency ablation (LTP-RFA) in treating T1a glottic cancer. Therefore, we conducted this study to compare the efficacy of CO2-LS and LTP-RFA to define a superior therapeutic modality for T1a glottic cancer.

Methods

Patients (n=131) with T1a glottic cancer were recruited between January 2010 and September 2014. The included patients were randomly assigned to either receive CO2-LS (n=65) or LTP-RFA (n=66). We conducted the following multidimensional vocal assessments: (i) videostroboscopic evaluation; (ii) auditory-perceptual evaluation; (iii) aerodynamics/ efficiency; (iv) acoustics; and (v) self-assessment questionnaires. Meanwhile, the surgery time and three-year overall survival rates in two groups were recorded. The predefined primary endpoint was overall survival, and the minimum follow-up time was set to six months.

Results

After treatment, we found that the structure and vibration of vocal cord might recover more quickly in patients receiving LTP-RFA than in patients receiving CO2-LS, and moreover, the patients in the LTP-RFA group had the better vocal functions. Meanwhile, the surgery time was significantly less in the LTP-RFA group (8.83±1.59 minutes) than in the CO2-LS group (12.49±1.40 minutes) (p<0.00001). In addition, the two intervention methods had the similar three-year overall survival rates (94% versus 96%, p=0.58).

Conclusion

These results indicated that both LTP-RFA and CO2-LS could effectively treat T1a glottic cancer, and LTP-RFA might have some advantages in voice function. Limited by the relatively small sample size, future studies were needed to validate our conclusion.

Outcomes of radiofrequency ablation (RFA) and CO2 laser for early glottic cancer

OBJECTIVE

In the present study, the voice and functional outcomes of radiofrequency ablation (RFA) and CO2 laser for early glottic cancer were evaluated.

METHODS

One hundred sixty eight patients with early glottic cancer from October 2007 to June 2015 were included. Ninety-seven patients underwent RFA and seventy-one patients underwent CO2 laser. The operation time and score of visual analog scale (VAS) for pain on the second day after surgery were recorded. The electronic laryngoscopy was performed at one week, one month and three months of postoperation.

RESULTS

The operation time in RFA was shorter than that in CO2 laser (8.52±1.43min vs. 11.76±1.67min, P<0.05). There was no statistical difference in VAS scores between two operation methods (2.86±0.52 vs. 2.89±0.68, P>0.05). One month after operation, the mucosal recovery in RFA group was better than that in CO2 laser group (P<0.05). The alterations of acoustic parameters Jitter, Shimmer and HNR at three time points after operation showed statistical significances in both RFA and CO2 laser groups (P<0.05). The significant differences in acoustic parameters between two groups were also observed (P<0.05). There were no differences in three-year survival rate, local recurrence rate, recurrence rate with anterior commissure involvement and postoperative adhesion rate with anterior commissure between the patients with RFA and CO2 laser (P>0.05). No patient underwent tracheotomy and had symptoms of bucking, dyspnea, severe pain, hemoptysis and other serious complications.

CONCLUSION

Both RFA and CO2 laser are safe and effective for the treatment of early glottic cancer. RFA has the advantage of quick voice recovery, low mucosa injury and short operation time, which is worthy for wide clinical application.

Radiofrequency transoral microsurgical procedures in benign and malignant laryngeal and hypopharyngeal lesions (institutional experiences)

Besides cold-steel and laser instruments, the use of radiofrequency (RF) devices in transoral microsurgery is getting increasing popularity mainly due to its minimal thermal effect on the collateral soft tissue. Authors summarize their surgical technique, results, and experience gained with RF applied during laryngeal interventions at the Department of Otorhinolaryngology, Head and Neck Surgery at Medical School, University of Pécs. Transoral microsurgery using radiofrequency was carried out in 23 cases in total between 1 January 2011 and 1 March 2013. Fourteen histopathologically different benign lesions and 9 malignant planocellular carcinomas of the larynx were removed using different Micro-Larynx RF Probes powered by Surgitron Dual 4.0 MHz Frequency RF (Ellman International, Oceanside, NY, USA) device. No major bleeding event occurred during or after the procedures and neither laryngeal oedema nor significant postoperative pain was recorded. Authors also reviewed the international literature in this topic while detailing some of their most interesting cases.

Radiofrequency ablation in the treatment of paediatric microcystic lymphatic malformations

Objective:

Congenital lymphatic malformations are a challenging clinical problem. There is currently no universally accepted treatment for the management of microcystic disease. We describe the novel use of an existing technology (radiofrequency ablation, also termed Coblation) for the debulking of paediatric microcystic lymphatic malformations involving the upper aerodigestive tract.

Methods:

Five children with microcystic or mixed-type lymphatic malformations were included in this retrospective case series.

Results:

Each child had a satisfactory outcome following radiofrequency debulking, with improved oral intake and airway symptoms. No serious complications were reported. These findings constitute level IV evidence.

Conclusion:

We recommend radiofrequency ablation as a safe, viable alternative to existing techniques for the treatment of paediatric microcystic lymphatic malformations of the upper aerodigestive tract. Radiofrequency ablation achieves effective debulking of microcysts whilst avoiding excessive bleeding and thermal damage to surrounding tissues. This paper constitutes the first report of successful treatment of airway obstruction due to paediatric laryngopharyngeal microcystic disease, using radiofrequency ablation.

Coblation resection of paediatric laryngeal papilloma

OBJECTIVE

To demonstrate the successful treatment of laryngeal papillomatosis in a 32-month-old girl, using coblation (radio-frequency ablation) resection.

CASE REPORT

A 32-month-old girl was referred to the ENT out-patients clinic due to a hoarse cry and a very croaky voice since birth. Under general anaesthesia, fibre-optic airway endoscopy revealed a large papillomatous lesion involving the anterior glottis, which was reported as a laryngeal papilloma on histological analysis. This was later excised using an Evac 70Xtra wand. The patient made an uneventful post-operative recovery, and there were no signs of recurrence on repeated airway endoscopies at three and 18 months.

CONCLUSION

Coblation (radio-frequency ablation) is a promising surgical technique for the treatment of paediatric laryngeal papillomatosis. The main advantages of this technique include limited damage to underlying tissues and a bloodless field.

Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis

Background:

A variety of treatment modalities are currently used to treat recurrent respiratory papillomatosis. We aimed to study the efficacy of radiofrequency cold ablation (coblation) for the treatment of laryngotracheal recurrent respiratory papillomatosis, by comparing treatment intervals for coblation and CO2 laser vaporisation.

Method:

Retrospective case series of adult patients with advanced laryngotracheal recurrent respiratory papillomatosis.

Results:

Six patients were treated for at least two years by CO2 laser vaporisation with or without intralesional cidofovir. All six subsequently underwent treatment with radiofrequency coblation with or without intralesional cidofovir. Coblation resulted in longer periods between interventions, compared with CO2 laser (p = 0.03).

Conclusion:

Radiofrequency coblation appears to be an attractive alternative technique to CO2 laser for the surgical treatment of advanced laryngotracheal papillomata.