Minimally invasive techniques gradually gain ground in ear, nose and throat surgery

Tübingen 15 December 1998 The early successes of minimally invasive interventions in both Argon-Plasma surgery (APC) and electrosurgery have inspired developers of medical tools to design new instruments for ear, nose and throat surgeons. It seems the multiple advantages of this alternative approach outweigh the results obtained with revolutionary but expensive techniques such as laser therapy. Slow but sure, new ways are paved to unsuspected possibilities and promising perspectives in the ear, nose and throat (ENT) departments of hospitals.

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The early successes of minimally invasive interventions in both Argon-Plasma surgery (APC) and electrosurgery have inspired developers of medical tools to design new instruments for ear, nose and throat surgeons. It seems the multiple advantages of this alternative approach outweigh the results obtained with revolutionary but expensive techniques such as laser therapy. Slow but sure, new ways are paved to unsuspected possibilities and promising perspectives in the ear, nose and throat (ENT) departments of hospitals.

One of the specialized companies in both APC and electrosurgical technology is ERBE Elektromedizin GmbH, based in Tübingen. In conjunction with the University Clinic of Mannheim, this manufacturer has designed a system with a series of special probes and applicators. Under the supervision of Dr. W. Bergler, the forms and functions of the different tools have been adapted to suit the particular needs of ENT surgery. Thanks to their ease of use, physicians are now able to successfully treat a variety of clinical symptoms in ENT with APC and electrosurgery.

APC allows the ENT surgeon to coagulate or devitalize in a safe and accurate manner tissues which need urgent treatment. The patient runs practically no risk of perforations anymore in severe cases, such as papillomatoses in the trachea or hemorrhages of mucous membranes in the septum, since the physician can precisely control the depth of the thermal effect. In the same way, it is possible to almost completely avoid injuries to sub-mucosal layers like cartilage. Plasma is applied at the distal end of the instrument in axial, lateral and radial directions without the surgeon having to enter into contact with the tissue.

Some of the clinical syndromes have a tendency to recur but APC treatment can be repeated as often as required without any noticeable damage to the healthy tissue. In turn, only slight tissue trauma is caused when applying APC to reduce diseased tissue in hyperplasia of the nasal concha. Patients are only submitted to radical interventions, such as blade resection, in the rare case of misalignment or if very large concha should occur. During the APC operation and while recovering, tamponading is no longer needed, since the patient is not troubled anymore by hemorrhages.

The Argon Plasma surgery kit comprises an electrosurgical unit, referred to as the ERBOTOM ICC 350, the plasma coagulation unit ERBE APC 300, a set of rigid and flexible applicators, and a number of flexible probes which have to be suitable for various medical indications. By means of ionized argon, the electric current is conveyed to the tissue. When the lesions are superficial, the surgeon is able to devitalize the tissue to a well defined and restricted depth with practically no danger of perforation. Hemostasis thus is safe and effective.

Profound analysis has shown that clinical symptoms of hemorrhagic tele-angiectasia have decreased after APC treatment. Patients who suffered from daily nose bleeds which went on over long periods of time, experienced a substantial reduction in the intensity and frequency of the bleeding, once the APC surgery had been performed. The clinical results for recurrent epistaxis seem therefore more than positive. APC has the additional advantage that the equipment is flexible, mobile and much more cost-effective in acquisition and maintenance than a laser system. Neither are required extensive safety measures.

APC already has been applied with excellent results in abdominal surgery, gastro-enterology, as well as bronchoscopy and is now conquering its place in ENT surgery. Further development and clinical testing of instruments to be used in other medical disciplines will turn APC into an efficient, useful and affordable alternative for successful treatment in a wide range of clinical specialities.


Leslie Versweyveld

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