Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada.
Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Quebec, Canada.
Otolaryngol Head Neck Surg. 2024 Aug;171(2):353-367. doi: 10.1002/ohn.734. Epub 2024 Mar 26.
We aim to systematically review the literature addressing perioperative practices for optimal use of the CO laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.
A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO laser in laryngeal TOLMS was conducted.
Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software.
Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up).
The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.
我们旨在系统地回顾文献，以了解 CO 激光在经口激光喉显微手术（TOLMS）中的围手术期应用实践，重点关注安全性。
对 Medline、Embase 和 EBM 评价-Cochrane 对照试验中心注册数据库中评估 CO 激光在喉 TOLMS 中应用的围手术期策略的出版物进行了系统评价。
通过 Covidence 软件，由 2 名独立研究人员进行 2 步评估，以评估检索策略获得的记录是否符合纳入标准。
在 2143 项确定的记录中，有 103 项纳入本研究。大多数研究（n=25）侧重于 CO 激光在肿瘤切除中的应用，而 20 项研究探讨了声带麻痹的治疗，16 项讨论了儿童或先天性疾病的治疗，11 项详细介绍了良性病变的处理，31 项研究涉及其他手术适应证。在研究之间，CO TOLMS 的安全策略高度多样化，包括术前措施（如与环境、人员准备、患者保护和通气有关）、术中预防措施（如保护非目标结构、技术考虑、局部和全身药物治疗）以及术后策略（如与气道保护、口服摄入、声带休息、住院时间、药物治疗方案和顾问随访有关）。
本研究提供的结果可作为指导各机构制定激光安全协议、指导质量改进计划、开发模拟培训活动的框架，以及作为促进住院医师教学和技能评估的工具。
