Complications and Failures of Office-Based Endoscopic Angiolytic Laser Surgery Treatment

Objectives/Hypothesis Although office-based laser surgery applications for benign and premalignant lesions of the larynx are appealing, there are scant data on their complications and failures. We review office-based angiolytic laser surgery in patients with benign laryngeal pathology for rates of complication and failure. Study Design Retrospective chart review. Methods Two hundred fifty-five patients who underwent in-office angiolytic laser surgery treatment over 4 years were reviewed. The criteria for complications and failures were based on postprocedure stroboscopy and clinical findings. Results The majority of patients had unilateral disease, which included polyps (46%), leukoplakia (14%), papilloma (13%), scar (12%), and varix (11%). There were 382 laser treatments, of which 56% were by pulsed potassium titanyl phosphate laser. Average energy delivery was lesion specific, with papilloma receiving the most (mean 351 J) and varices receiving the least (mean 53 J) energy. Most in-office treatments were tolerated well. Four percent of patients had complications including stiffness, atrophy, and transient but prolonged hyperemia. Twenty-seven percent of patients required multiple laser treatments. Multiple treatments were more likely in papilloma and leukoplakia. Conclusions While in-office laser therapy for benign vocal fold lesions is appealing, repeated treatment due to incomplete resolution may be needed. Risks of transient and long-term complications are low but real. Patient selection and standardized laser energy parameters may help in decreasing complications and need for repeat procedures.