The surgeon uses a laser to remove the cancer through your mouth. A laser is a thin hot beam of light. You don't need a surgical cut (incision) in your neck.
What it is
This operation is called endoscopic resection. It is also called:
- transoral laser microsurgery (TLM)
- transoral resection of the larynx (TORL)
Transoral means your surgeon removes tissue through your mouth. They use a laser. The laser cuts through tissue in the same way as a surgical knife (scalpal) but causes less bleeding. The type of laser most often used is a carbon dioxide laser.
Who has laser surgery
Laser surgery through the mouth is a treatment for early stage and locally advanced laryngeal cancers.
This treatment might not be suitable for you if you have neck problems, such as neck stiffness.
How you have it
You have this surgery at a hospital under general anaesthetic. You will be asleep during the operation.
The surgeon puts a rigid tube (endoscope) into your mouth and down your throat as far as your voice box. They use a laser to cut away the cancer. The laser is a fine, hot beam of light. It is attached to a microsope, so your surgeon can see the cancer very clearly.
Before your surgery
You will have tests to make sure you are fit enough for surgery.
Your anaesthetist will check your teeth and throat to check for possible problems in passing the tube (endoscope) into your mouth.
After your operation
How long you stay in hospital depends on the size of operation you need.
For a small, early stage tumour
You might have your operation as day surgery or stay in hospital overnight.
You might be able to eat and drink as soon as you are fully awake. Your throat will feel sore for a while when you swallow. Your nurse will give you painkillers to take home.
For a larger tumour
You might need to be in hospital for a few days. After your operation you might be on an ear, nose and throat (ENT) ward. Or you might be in an intensive care unit (ICU) or high dependency unit (HDU) for 1 or 2 nights.
Your nurses check regularly for any bleeding or swelling of your voice box.
Swelling can make it harder to breathe. In rare cases where swelling gets really bad, you might need to have an opening made in the front of your throat. This is made just above the voice box to help you breathe. It is called a tracheostomy and is usually only temporary, until the swelling goes down.
You might need to have liquid food through a tube put down your nose into your stomach (a nasogastric tube) if you have difficulty swallowing. You have a drip into a vein to give you fluids and medicines.
You may not feel pain straight after your surgery, if you’ve had painkillers with your anaesthetic. The laser surgery itself also numbs the nerves.
You might feel pain when the numbness wears off. So it is important to ask for painkillers as soon as you need them. You might have them into your drip at first, if swallowing is painful.
It is important to get up and move around as soon as possible to help your recovery. Your physiotherapist might give you leg exercises to reduce the risk of blood clots.
Effects on your voice
Laser surgery might affect your voice. The changes can be temporary or long term. Your surgeon might ask you to avoid speaking for the first few days after your operation.
Your speech therapist gives you exercises to help your voice recover. They can also give you advice and exercises to help you with any swallowing difficulties.
Before you leave hospital your nurse will give you a follow up appointment to see your speech therapist as well as your surgeon.
Possible problems during laser surgery
Very occasionally during laser surgery, some people have chipped teeth or bruised lips or gums from the breathing tube that is put into your mouth.
Chipped teeth can be repaired by a dentist if needed. Any bruising of the lips or gums will go down after a few days.
Sometimes the laser might cause burns to tissues around the tumour. Your doctor will discuss these risks with you.