[Direct video-laryngoscopy].

The combination of modern bivalved operative laryngoscopes, laryngeal telescopes and videotaping techniques has given us a new tool in the objective evaluation of organic laryngeal lesions. The purpose of the present study has been to describe a new method for direct video-laryngoscopy, an alternative to the classical Kleinsasser microlaryngoscopy technique, in diagnosis, clinical documentation and endolaryngeal microsurgery under video control without using an operating microscope. The direct video-laryngoscopy system consists of: a Weerda distending operating laryngoscope, Hopkins rod lens and Lumina telescopes (0 degrees, 25 degrees, 70 degrees or Mueller subglottoscope), an original telescope holder for a distending laryngoscope, a lightweight medical videocamera, a VHS videorecorder, laryngoscope holder and chest support. From November 1987 to May 1989, 370 patients with laryngeal lesions were examined and recorded. Only in 3 cases was the microlaryngoscopy technique used as it proved difficult to introduce the telescope into its holder because of patient anatomy: one short-necked, obese patient, and two with a prominent tongue base and limited ability to open the mouth. In 367 cases direct video-laryngoscopy made careful diagnosis possible leaving a permanent record of the size and extent of the lesion. Such information could be used in accurate staging and follow-up. 320 patients were also treated by endolaryngeal microsurgery under video control without an operating microscope. Thanks to the width of the bivalved scope, the space for microsurgical instruments would be appreciably extended laterally, making it possible to better control the instruments on the monitor. The telescope lies on the superior spatula of the laryngoscope without interfering with the surgical procedures. The video material obtained was of high quality and of great value for diagnosis, pre- and post-operative evaluation, follow-up and documentation of various laryngeal disorders.