Laser Vocal Cord Surgery: Choosing the Right Equipment

What transoral laser microsurgery involves

In transoral laser microsurgery (TLM) the surgeon works through a laryngoscope with the patient under general anaesthesia, viewing the larynx through an operating microscope. A CO2 laser is coupled to the microscope via a micromanipulator, so the beam follows the line of sight and the spot is placed with a small joystick or lever.

Fibre-delivered lasers offer a different approach: a thin fibre is passed through the laryngoscope or an endoscope and used close to or in contact with tissue. Both approaches are used in laryngology, and many centres keep both.

Whichever technique is used, good exposure of the larynx and a stable suspension setup are as important as the laser. The equipment should support the surgeon's workflow rather than dictate it.

CO2 laser larynx work: articulated arm and micromanipulator

The A.R.C. C-Las is a 30 W CO2 laser (10 W in Super Pulse) with an articulated mirror arm and the C-Pro micromanipulator. The manufacturer states a 100 µm spot, a continuously adjustable working distance of 200 to 500 mm, compatibility with all common surgical microscopes, and a focus/defocus lever to switch between cutting and coagulation.

Pulse length ranges from 20 to 500 ms or continuous wave. It is air-cooled, weighs 32 kg and has a colour touchscreen. For microscope work, check microscope compatibility, spot quality at your working distance, and how smoothly the micromanipulator moves.

Superpulse and short-pulse modes are generally used to limit thermal spread, while continuous mode is used for faster tissue division. Ask the supplier how modes are selected on the touchscreen and whether settings can be stored for individual surgeons.

Fibre lasers for the larynx

A fibre laser such as the 445 nm WOLF TruBlue is delivered through flexible, colour-coded HiFLEX fibres and the manufacturer describes it as combining cutting with coagulation. Its portability suits office-based procedures as well as theatre use, and our blue laser ENT article covers the details.

To avoid choosing between the two, the CO2 DUO3 Concept pairs the C-Las CO2 laser with a fibre-guided second wavelength, either CORAL Blue 445 nm or CORAL Green 514 nm, so the surgeon can switch during a procedure and each laser can also be used on its own.

Theatre setup and safety

Laryngeal laser surgery shares the airway with the anaesthetist, which is why fire prevention is central: laser-safe tubes, controlled oxygen concentration, wet protective materials and a rehearsed team protocol. Read our dedicated guide to airway fire prevention.

Plan smoke evacuation near the field, protective eyewear for the wavelength, signage and controlled access. Our laser operating room requirements article lists room-level considerations.

• Suspension laryngoscope and microscope compatibility with the micromanipulator.
• Smoke evacuation inlet close to the field.
• Protective eyewear and warning signs.
• Anaesthetic plan agreed before the first laser pulse.

Questions to ask before purchase

Ask which microscopes the micromanipulator has been used with, what training and proctoring is provided, what the service and calibration plan is in the UAE, and which accessories are included. Request a demonstration in your theatre.

Beckfinity can arrange a demonstration of the C-Las, WOLF TruBlue or DUO3 combinations. Request a quote or consultation from our specialists.

Also confirm what is supplied with the system: handpieces for freehand work, protective goggles, a smoke evacuation connection and a dedicated trolley. A complete kit avoids last-minute purchases before the first list.