Use of the KTP-Laser in Totally Endoscopic Cholesteatoma Surgery

Sharma, Sunil1; Swarup, Arushri1; Cushing, Sharon1; Papsin, Blake1; James, Adrian
1 Department of Otolaryngology – Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Canada

Introduction: KTP-laser has been shown to reduce rates of residual cholesteatoma after microscope-guided surgery. We review our experience of KTP-laser in transcanal totally endoscopic cholesteatoma surgery (TEES).

Study design: Prospective cohort study
Setting: Tertiary referral center
Patients: Consecutive series of 104 TEES cholesteatoma cases, average age 10.5 years (range 1.8 – 18)
Intervention: TEES with or without KTP-laser

Main Outcome Measures: Proportion of cases in which KTP-laser was required; reasons for KTP-laser use; residual cholesteatoma rate; strategies for facilitating use of KTP-laser.

Results: KTP-laser was used in 84 (81%) cases to (1) reduce the risk of leaving unseen remnants (2) remove matrix from challenging areas, (3) ablate granulation tissue. Laser was not used in 20 “clean” cases in which disease was removed easily. Residual disease was detected in four (4%) cases, of which the KTP-laser had been used in three. Excluding 27 cases with inadequate follow up (<1 year since surgery, second stage surgery or screening-MRI pending), residual disease was detected in 3/57 (5%) of KTP-laser cases. No complications were associated with KTP-laser. A clear view of the operative field without laser-glare or smoke is maintained by attaching a 532nm filter and a suction cannula to the endoscope. Laser safety regulations must allow the surgeon a clear view of the monitor.

Conclusion: The use of KTP-laser with endoscopic visualisation provides an effective combination for minimising the risk of residual disease using a minimally invasive surgical approach. The thin semi-flexible fiber-carrier of the KTP-laser is ideally suited to work alongside the endoscope within the narrow confines of the ear canal.