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Transoral Laser Microsurgery

Transoral laser microsurgery (TLM) was first proposed in 1972 and is now widely used for tumors of the throat and larynx (voice box).  

With TLM, a highly specialized carbon dioxide (CO2) laser beam is used instead of a scalpel to cut through the tissue. Unlike other types of lasers, the CO2 laser beam generates minimal heat energy. This limits damage to normal structures around the tumor, such as important nerves, blood vessels and muscles, which are important for speech and swallowing. The surgery is performed directly through the mouth and does not leave a visible scar. The surgeon inserts a thin endoscope through the mouth, and a specially designed microscope lets the surgeon see the tumor and surrounding tissue during the surgery.

At MD Anderson, your surgeon will help you decide if TLM is right for you. Patients undergoing transoral laser microsurgery for throat or larynx cancer are placed under general anesthesia. 

Different CO2 laser systems are available for use with transoral laser microsurgery. If you are diagnosed with early-stage cancer of the larynx, then Digital AcuBlade™ laser surgery may be used. With this method, CO2 laser is delivered through a specialized robotic adapter that creates precise incisions. The system, designed by Lumenis Surgical specifically for larynx and vocal cord surgery, uses a computer with an operating microscope. The surgeon programs the computer by entering information about the specific type of procedure that will be performed, the laser beam pattern, the incision length and the depth that the laser will penetrate. The surgeon positions the laser beam on the larynx or vocal cord and performs the procedure by manipulating a joystick on an operating microscope. The CO2 laser moves in straight, curved, or circular patterns to sculpt the most precise incision with the least effect on surrounding normal tissue.  

Another type of laser used with TLM is flexible fiber-optic CO2 laser. In 2004, surgeons at MD Anderson were the first to use fiber-optic CO2 laser to reach areas in the throat that otherwise could not be reached and to perform a 360-degree resection around tumors in ways that were previously not possible.

If your surgery for throat cancer has a high risk of bleeding, surgeons at MD Anderson may use thulium laser instead of CO2 laser.  The thulium laser is used instead of a scalpel to cut through tissue. It is very precise and is designed to minimize the risk of blood loss during surgery. The skilled surgeons at MD Anderson will choose between a pulsed laser beam and a continuous laser beam to perform the best surgery for you.  

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