CO₂-Lasertonsillotomy Under Local Anesthesia in Adults

This carbon dioxide-laser tonsillotomy technique results in fewer perioperative complications such as bleeding;patients experience less post-operative pain as well. The main advantages of this technique over classic dissection tonsillectomy are lack of general anesthesia and patients recover faster. Demonstrating this procedure with me will be Rozemarie Van Geet, who will be acting as the surgical technologist for this intervention.

Before beginning a procedure, attach the laser pen to the carbon dioxide-laser machine and set the appropriate parameters on the instrument. Make sure that everyone is wearing laser safety glasses and everyone but the patient is wearing appropriate protective surgical masks. Confirm that the surgical headlight is working, then place a pulse oximeter on the patient's index finger and confirm that the oximeter is functioning correctly.

Place a supply of wooden tongue depressors within reach, then position the patient in an upright position and set the patient to a comfortable height for performing the laser treatment. After inspecting the tonsils and excluding any active inflammation, use a topical anesthesia on the tongue base and pharynx in patients with a significant gag reflex before injecting approximately 200 microliters of local anesthetic into the upper pole, the mid-pole, and lower pole of each tonsil. Instruct the patient to spit out any excess anesthetic and reassure the patient that any feeling of throat tightness is due to the anesthesia and not to any actual obstruction.

For laser treatment of the tonsil, have the patient breathe in deeply and exhale slowly and have the surgical technologist hold the smoke suction close to the opening of the mouth without blocking the view. Make sure the laser is functioning correctly by firing one or two laser shots at the wooden tongue depressor. Using two wooden tongue blades, depress the tongue and tongue base to expose the tonsil and during the patient's exhalation laser the lymphatic tissue of the lobules in a sweeping motion.

To expose the tonsil further, use the wooden tongue blades to press against the anterior tonsillar pillar. To expose the upper lobule of the tonsil, use the wooden tongue blades to press against the upper part of the tonsil pillars. To expose the lower tonsil lobule, use the wooden tongue blades to scoop up the tissue to facilitate their laser treatment while they are being held on the tongue blades.

Stop when the patient taps the surgeon's leg and allow the patient to catch a breath before continuing the laser treatment. If indicated, repeat anesthesia and laser treatment of the second tonsil until complete cryptolysis is accomplished. An adequate view of the treated tissue is of utmost importance.

Asking the patient to exhale very slowly during treatment will help maintain visibility of the tonsil area. In this representative prospective study of 107 patients, 46 patients underwent conventional tonsillectomy under general anesthesia and 61 patients underwent carbon dioxide-laser tonsillotomy. The overall satisfaction rate was similar in both treatment groups, but the days to full recovery and the number of post-operative bleeding events were both significantly higher in the tonsillectomy group.

Patient selection and preoperative instructions are important to the success of the procedure. Furthermore, it's important to make sure the patient is as calm and comfortable as possible. Adequate laser safety precautions are essential for the safety of the patient and the medical staff.

Make sure your room meets the correct laser safety standards and use the right equipment.