Recurrent Respiratory Papillomatosis Office versus Operating Room: Systematic Review and Meta-Analysis

Laryngeal Papillomatosis

Laryngeal papillomatosis and recurrent respiratory papillomatosis are caused by the human papillomavirus. It is characterized by papillomatous growths and is the most common benign disease of the larynx. Juvenile-onset RRP is characterized by more aggressive disease compared with adult-onset RRP. Patients often require frequent surgical procedures, with an increasing shift toward office-based treatment. A variety of surgical and adjuvant medical therapies are available with mixed responses. New targeted therapies and vaccines are currently under investigation as potential adjuncts in the management.

Does the setting for intradetrusor onabotulinumtoxinA injection for management of overactive bladder matter?

Introduction

Intradetrusor onabotulinumtoxinA (Botox) injections, to treat idiopathic overactive bladder (OAB), can be performed in the office setting under local analgesia alone or in the operating room (OR) under local and/or sedation. The objective of this study was to compare the symptomatic improvement in patients with OAB who underwent treatment with intradetrusor onabotulinumtoxinA injections in an in-office versus the OR setting.

Methods

We performed a multicenter retrospective cohort study of women with the diagnosis of refractory non-neurogenic OAB who elected to undergo treatment with intradetrusor onabotulinumtoxinA injections between January 2015 and December 2020. The electronic medical records were queried for all the demographic and peri-procedural data, including the report of subjective improvement post procedure. Patients were categorized as either "in-office" versus "OR" based on the setting in which they underwent their procedure.

Results

Five hundred and thirty-nine patients met the inclusion criteria: 297 (55%) in the in-office group and 242 (45%) in the OR group. A total of 30 (5.6%) patients reported retention after their procedure and it was more common in the in-office group (8.1%) versus the OR group (2.5%), (P = 0.003). The rate of urinary tract infection within 6 months of the procedure was higher in the OR group (26.0% vs. 16.8%, P = 0.009). The overall subjective improvement rate was 77% (95% confidence interval: 73%-80%). Patients in the OR group had a higher reported improvement as compared to the in-office group (81.4% vs. 73.3%, P = 0.03).

Conclusions

In this cohort study of patients with OAB undergoing intradetrusor onabotulinumtoxinA injections, post procedural subjective improvement was high regardless of the setting in which the procedure was performed.

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

This paper reports the design, construction, and experimental validation of a novel hand-held robot for in-office laser surgery of the vocal folds. In-office endoscopic laser surgery is an emerging trend in Laryngology: It promises to deliver the same patient outcomes of traditional surgical treatment (i.e., in the operating room), at a fraction of the cost. Unfortunately, office procedures can be challenging to perform; the optical fibers used for laser delivery can only emit light forward in a line-of-sight fashion, which severely limits anatomical access. The robot we present in this paper aims to overcome these challenges. The end effector of the robot is a steerable laser fiber, created through the combination of a thin optical fiber (ϕ 0.225 mm) with a tendon-actuated Nickel-Titanium notched sheath that provides bending. This device can be seamlessly used with most commercially available endoscopes, as it is sufficiently small (ϕ 1.1 mm) to pass through a working channel. To control the fiber, we propose a compact actuation unit that can be mounted on top of the endoscope handle, so that, during a procedure, the operating physician can operate both the endoscope and the steerable fiber with a single hand. We report simulation and phantom experiments demonstrating that the proposed device substantially enhances surgical access compared to current clinical fibers.

[Office-based phonosurgery]

Wesentliche und neue Impulse, die das Behandlungskonzept für ambulante phonochirurgische Eingriffe am unsedierten Patienten betreffen, stammen aktuell aus dem angloamerikanischen Sprachraum. Die dort etablierten „office-based procedures“ werden als eine Alternative zu vielen konventionellen operativen Larynxeingriffen in Vollnarkose propagiert. Maßgeblich für diese Entwicklung ist der Einsatz neuer endoskopischer Techniken in Kombination mit photoangiolytischen Laserverfahren (KTP-Laser und blauer Laser), die eine sichere und effiziente ambulante Phonochirurgie ermöglichen. Die Akzeptanz seitens der Patienten ist hoch, da ambulante Eingriffe als risikoärmer gelten. Ungeachtet der verbreiteten Euphorie fehlen weiterführende Studien, welche die medizinischen Entscheidungskriterien und das Sicherheitsmanagement bei dieser neuen ambulanten Ausrichtung der Kehlkopfchirurgie bewerten.