Transoral Laser Microsurgery - State of the Art and the Perspectives

The indications for transoral laser microsurgery (TOLMS) have evolved over the past decades. Firstly, the method was introduced for early glottic cancer, including Tis and T1. Then, with proved good efficacy of the modality, the indications expanded not only to a wide range of benign lesions but to more advanced laryngeal tumors T2 and selected T3. With the improvement of diagnostic work-up, TOLMS has become not only an alternative to open partial laryngeal surgery for laryngeal cancer, but also an effective alternative to pharyngotomy for early hypopharyngeal cancers.

The well-established position of TOLMS in treatment protocols has been owned its high effectiveness, together with minimal invasiveness, good postoperative function and low complication rates. The relevant classification system of cordectomies types for TOLMS proposed by European Laryngological Society and followed by supraglottic resections nomenclature arrangement contributed with significant extent to the widespread acceptance of the modality.

Primary external beam radiotherapy (RT) is currently the major competitive treatment method to TOLMS for early laryngeal cancer, with similar survival rates but with lower cost-effectiveness. Controversy over the superiority of each method are the causes of ongoing debate. The factors at issue include the functional results with voice quality and swallowing dysfunction as major aspects, quality of life, probability of preserving the larynx and possibilities of salvage treatment options.

TOLMS, as a minimally invasive surgical technique, has important issues that need constant monitoring and adequate improvement. With this method, the concept of piecemeal tumor resection was adapted and the ultra-narrow margins (usually 1–3 mm) were implemented. The laser coagulation artefacts, together with specimen shrinkage, are additional aspects related with this type of modality. The accurate margin assessment requires therefore the optimization of TOLMS-tumor boundaries identification and TOLMS-specimen orientation and evaluation. The improvement of endoscopic techniques with implementation of enhanced visualization, fluoroscopic methods and novel tissue biomarkers meets the expectations and create opportunities for even greater precision for the modality.

On the other hand, as in other surgical fields, we observe growing competition related to transoral robotic surgery (TORS) and transoral esoscopic surgery (TOES) that are increasingly used in laryngeal surgery.

With this Topic collection we would like to encourage all interested authors to share their latest findings, sum up existing protocols, highlight new ideas and insights for further exploitation of the method. All the effort to stimulate the invigorating and intensive discussion leading to innovative solutions for the indicated modality.

Varied contributions from Original Research to Review Articles are invited.