Combining a new CO₂ laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors

We present a series of patients treated by transoral robotic surgery (TORS) using a new CO₂ laser wave guide (CO₂ LWG) (Lumenis, Santa Clara, CA). Patients older than 18 years, with malignant pharyngo-laryngeal tumors were enrolled in this prospective study after signing an informed consent. Four patients were enrolled in the study. The mean age was 56 years. One patient had a T1 base of tongue tumor, two patients had supraglottic tumors (T1, T2), and one had a T1 palatine tonsil tumor. All the procedures could be performed using a Maryland forceps, a 0° endoscope and a CO₂ LWG introduced via the robotic arm introducer. The laser parameters were: superpulse or continuous mode, 7–15 W, continuous delivery. The average set-up time was 30 min. The average surgical time was 94 min. No complications were noted due to the intraoperative use of the robot or the CO₂ LWG. One laser fiber was used for each of the surgeries. The mean coagulation depth was 200 μm (range 100–300). The mean hospital stay was 6 days. The CO₂ LWG is a reliable tool for TORS. It allowed more than 1 h of work without any trouble.