OBJECTIVE: We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.
METHODS: A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted.
METHODS: Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software.
RESULTS: Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up).
CONCLUSIONS: The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.

Introduction: Lasers in oral surgery have been extensively studied in recent years. Laser treatment is now a well-known technology that is frequently employed on oral soft tissues. The carbon dioxide (CO2) laser was one of the first soft tissue removal lasers. Because of the strong affinity of the CO2 laser to water, it is best used for removing, vaporizing, and coagulating these tissues. In minor oral surgery, CO2 laser therapy has shown advantages. Therefore, this study examined the CO2 laser use in minor oral soft tissue surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed in this study. A question for research encompassing the inclusion criteria for the participants, intervention, comparison, outcome, and study design (PICOS) was formulated. The search queries were entered into the PubMed/Medline, Scopus, and Embase databases. Consideration was given to publications published between January 1, 2018 and March 15, 2023. Results: The research included 37 studies after narrowing search results, eliminating duplicate titles, and conducting an eligibility review (three animal studies, seven case reports, three case series, and twenty-four clinical studies). CO2 lasers alone or in combination with other therapies successfully treated oral potentially malignant disorders (OPMDs), oral tumors, oral fibrous-epithelial lesions, gingival melanin hyperpigmentation, pyogenic granuloma, socket preservation, mucocele, high labial frenulum attachment, and so on. CO2 lasers reduced intra- and postoperative complications and adverse effects, improved postoperative functional results, ablated tissues with precision, and minimized disease recurrence and malignant transformation. Conclusion: Our study found that the CO2 laser in oral minor surgeries is successful, but further randomized clinical trials and multicenter studies are recommended to compare CO2 laser surgery to other treatments.

OBJECTIVE: There is no agreement on the most appropriate post-operative pathway for the management of positive margins after laser cordectomy for early stage glottic tumours (T1-2N0M0). This literature review and meta-analysis aim to evaluate the post-operative treatment with the best oncological results among follow-up, radiotherapy (RT) and surgical second look. The parameters utilized were incidence of recurrence, overall (OS), disease-specific (DSS) and disease-free (DFS) survival and larynx preservation (LP).
METHODS: The articles were found through a string typed into PubMed from 2007 to 2022. The studies with detailed oncological results were selected according to inclusion criteria, and then the meta-analysis was carried out.
RESULTS: Sixteen studies met the inclusion criteria for 2808 patients. The positive margin was found in 748 patients (26.6%), of which 416 were referred to follow-up, 89 to RT and 242 to a surgical second look. A false positive margin was found in 58/104 patients (56%). The recurrence rate in patients with positive margins was significantly higher (p = 0.003). In OS, DSS, DFS and LP, the odds ratio (OR) value was always greater than 1, assessing the role of the positive margin as a risk factor.
CONCLUSIONS: Prospective studies will be necessary to establish the role of positive margin as a prognostic factor. A surgical second look in case of positive margin seems to be the best option for the patient in terms of lower risk of recurrence and better oncological results. Better collaboration between surgeon and pathologist would be desirable to limit the real and false positive margins.

UNASSIGNED: Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP.
UNASSIGNED: A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up.
UNASSIGNED: Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis.
UNASSIGNED: Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies must be taken into consideration.
La papillomatosi laringea ricorrente: strategie terapeutiche multimodali. Revisione della letteratura e analisi retrospettiva multicentrica.
UNASSIGNED: La papillomatosi recidivante delle vie respiratorie è una rara patologia benigna causata dal Papilloma virus umano (HPV) e può essere suddivisa in una forma giovanile ed una dell’adulto. Il decorso della malattia è variabile, di solito più aggressivo nella forma giovanile. Il trattamento chirurgico standard è rappresentato dalla resezione con laser CO2, anche se i laser fotoangiolitici possono rappresentare una valida alternativa. L’utilizzo di terapie adiuvanti è stato proposto per il controllo della malattia nei casi che richiedono trattamenti chirurgici frequenti o che tendono a diffondere nelle vie respiratorie inferiore. L’alfa-interferon è stato uno dei primi farmaci ad essere utilizzati, seguito dal cidofovir. Negli ultimi anni, lo sviluppo dell’immunoterapia ha condotto all’utilizzo del bevacizumab sia per somministrazione intralesionale o sistemica, ma lo sviluppo terapeutico più promettente è rappresentato dalla vaccinazione anti HPV. Lo scopo di questo lavoro è di presentare una revisione della letteratura e l’esperienza di tre differenti Centri Universitari nel trattamento della papillomatosi recidivante delle vie respiratorie.
UNASSIGNED: È stata condotta un’analisi retrospettiva sulle cartelle cliniche dei pazienti affetti da papillomatosi laringea e trattati in tre differenti Centri Universitari tra il 2002 e il 2022. Sono stati analizzati i seguenti parametri: sesso, età alla prima visita, siti laringei coinvolti, sierotipi di HPV, tipologia del primo trattamento chirurgico, presenza e numero di recidive, trattamento chirurgico delle recidive, terapie adiuvanti, effetti collaterali e status all’ultimo follow-up.
UNASSIGNED: Settantotto pazienti sono stati selezionati per lo studio. Di questi, l’88% presentava papillomatosi dell’adulto (Ao-RRP) e il 12% una forma giovanile (Jo-RRP). La glottide è risultata la sottosede più coinvolta; tutti i pazienti sono stati sottoposti a chirurgia con laser CO2 in anestesia generale. Recidive sono state osservate nel 79% dei pazienti, i pazienti che non hanno mostrato recidive erano tutti adulti. Il numero medio di recidive è stato di 9 (range 1-110). Le recidive sono risultate più frequenti nei bambini (M = 20; range 2-110); rispetto agli adulti (M = 5; range 1-21). Il 52% dei 62 pazienti con recidiva è stato ritrattato con laser CO2 laser in anestesia generale, mentre nell’altro 48% dei pazienti è stata scelta una procedura ambulatoriale con un laser fotoangiolitico. Terapie adiuvanti sono state impiegate in 26 pazienti. L’analisi del decorso della malattia ha rivelato che nei 9 pazienti con papillomatosi giovanile, 6 (67%) erano liberi da malattia all’ultimo follow-up, mentre gli altri 3 (33%) avevano ancora papillomi. Dei 69 pazienti con papillomatosi dell’adulto, 53 (77%) erano liberi da malattia all’ultima visita; 14 (21%) presentavano ancora papillomi; 1 (1%) è stato perso al follow-up e 1 (1%) è morto per altra malattia. Effetti collaterali severi sono stati riscontrati solo in 2 pazienti che hanno sviluppato una stenosi glottica posteriore.
UNASSIGNED: I risultati hanno confermato quelli della revisione della letteratura. La papillomatosi respiratoria ricorrente è una malattia potenzialmente aggressiva, specie nell’insorgenza giovanile. La resezione chirurgica è ancora il trattamento di prima linea, ma in caso di multiple recidive è necessario prendere in considerazione l’uso di terapie adiuvanti.

UNASSIGNED: The use of lasers has been increasing in various surgical procedures. Its specific characteristics have conquered the scalpel used to a major extent in certain surgical procedures. This scoping review aimed to assess the empirical evidence that exists on the quality of life (QoL) of dental patients treated with laser surgery.
UNASSIGNED: This scoping review was conducted in accordance with the Arksey and O\'Malley\'s guidelines for scoping reviews. Four electronic databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo) were systematically searched through a stepwise approach, informed by the PEO (Population [P], Exposure [E], and Outcome [O]) framework, to retrieve literatures relevant to the review question. After a two-staged and Rayyan-aided screening process, only those literatures meeting the inclusion criteria were included into the review. From the included literatures, data were extracted, collated, summarized, and presented.
UNASSIGNED: The literature search retrieved 246 articles, of which only 10 articles were selected according to the inclusion criteria. Five of the studies were from the United Kingdom and three were from Italy. Study designs were either cohort (60%) or randomized controlled trials (40%). A vast variation was observed in the study populations. The used QoL instruments were mostly disease/condition-specific and oral cancer was the most reported disease in the included articles. The patients who underwent laser surgery had better QoL on the 7th day postoperatively, although it was not significant in later days.
UNASSIGNED: Depending on the indication, Laser is a safe surgical approach that could enhance the clinical outcome as well as the QoL of dental patients. Laser effects were more significant in the domain of postoperative pain. Due to the limited number of studies evaluated in this review, further longitudinal studies are needed to corroborate the findings of this review.

Optical Coherence Tomography (OCT) is an optical imaging technology occupying a unique position in the resolution vs. imaging depth spectrum. It is already well established in the field of ophthalmology, and its application in other fields of medicine is growing. This is motivated by the fact that OCT is a real-time sensing technology with high sensitivity to precancerous lesions in epithelial tissues, which can be exploited to provide valuable information to clinicians. In the prospective case of OCT-guided endoscopic laser surgery, these real-time data will be used to assist surgeons in challenging endoscopic procedures in which high-power lasers are used to eradicate diseases. The combination of OCT and laser is expected to enhance the detection of tumors, the identification of tumor margins, and ensure total disease eradication while avoiding damage to healthy tissue and critical anatomical structures. Therefore, OCT-guided endoscopic laser surgery is an important nascent research area. This paper aims to contribute to this field with a comprehensive review of state-of-the-art technologies that may be exploited as the building blocks for achieving such a system. The paper begins with a review of the principles and technical details of endoscopic OCT, highlighting challenges and proposed solutions. Then, once the state of the art of the base imaging technology is outlined, the new OCT-guided endoscopic laser surgery frontier is reviewed. Finally, the paper concludes with a discussion on the constraints, benefits and open challenges associated with this new type of surgical technology.

Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults.
This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI.
Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p < 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p < 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate.
Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.

UNASSIGNED: Cowden\'s syndrome is a genetic disorder characterized by multiple oral hamartomas and an increased risk of internal malignancy. These mucocutaneous lesions can be physically disfiguring and psychologically distressing. As a result, patients frequently seek treatment for their destruction. Removal of oral hamartomas is often a challenge due to their sensitive location and high risk of recurrence.
UNASSIGNED: To review the clinical use, effectiveness, and safety of a fractional ablative laser to treat multiple oral hamartomas in a patient with Cowden\'s syndrome.
UNASSIGNED: A thorough literature review pertaining to treatment of oral hamartomas and a discussion of an illustrative case showcasing successful lesional destruction with a fractional ablative carbon dioxide (CO2) laser in a 33-year-old man with Cowden\'s syndrome.
UNASSIGNED: Multiple oral hamartomas were effectively removed with fractional CO2 laser vaporization. No infection, scarring, dermatitis, nor lesional recurrence were observed 6 months post-treatment.
UNASSIGNED: Fractional CO2 laser vaporization can be used effectively to treat multiple oral hamartomas associated with Cowden\'s syndrome.

Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.

OBJECTIVE: Monochorionic twins with twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP) are at increased risk of neurodevelopmental impairment (NDI). This meta-analysis aimed to identify the prevalence of and perinatal risk factors for NDI in TTTS survivors treated with FLP.
METHODS: We performed a search in PubMed, EMBASE, Scopus and Web of Science, from inception to 13 February 2021, for studies evaluating perinatal risk factors for NDI in children diagnosed prenatally with TTTS managed by FLP. Data on severity of TTTS at the time of diagnosis, defined according to the Quintero staging system, FLP-related complications and perinatal outcomes were compared between children with a history of TTTS treated with FLP with and those without NDI, which was defined as performance on a cognitive or developmental assessment tool ≥ 2 SD below the mean or a defined motor or sensory disability. A random-effects model was used to pool the mean differences or odds ratios (OR) with the corresponding 95% CIs. Heterogeneity was assessed using the I2 statistic.
RESULTS: Nine studies with a total of 1499 TTTS survivors were included. The overall incidence of NDI was 14.0% (95% CI, 9.0-18.0%). The occurrence of NDI in TTTS survivors was associated with later gestational age (GA) at FLP (mean difference, 0.94 weeks (95% CI, 0.50-1.38 weeks); P < 0.0001, I2  = 0%), earlier GA at delivery (mean difference, -1.44 weeks (95% CI, -2.28 to -0.61 weeks); P = 0.0007, I2  = 49%) and lower birth weight (mean difference, -343.26 g (95% CI, -470.59 to -215.92 g); P < 0.00001, I2  = 27%). Evaluation of different GA cut-offs showed that preterm birth before 32 weeks was associated with higher risk for NDI later in childhood (OR, 2.25 (95% CI, 1.02-4.94); P = 0.04, I2  = 35%). No statistically significant difference was found between cases with and those without NDI with respect to Quintero stage of TTTS, recipient or donor status, development of postlaser twin anemia-polycythemia sequence, recurrence of TTTS and incidence of small- for-gestational age or cotwin fetal demise.
CONCLUSIONS: TTTS survivors with later GA at the time of FLP, earlier GA at delivery and lower birth weight are at higher risk of developing NDI. No significant association was found between Quintero stage of TTTS and risk of NDI. Our findings may be helpful for parental counseling and highlight the need for future studies to understand better the risk factors for NDI in TTTS survivors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.