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CC BY 4.0 · Endoscopy 2023; 55(S 01): E749-E750
DOI: 10.1055/a-2085-0774
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Double-scope endoscopic submucosal dissection of superficial laryngeal cancer to preserve the superior laryngeal nerve

Yoshinori Horikawa 
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Koichi Hamada 
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
2   Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
,
Yoshiki Shiwa
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Yusuke Mada
3   Department of Otolaryngology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Kae Techigawara
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Masafumi Ishikawa
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Akiyoshi Ishiyama
4   Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Endoscopic submucosal dissection (ESD) is a minimally invasive surgery for laryngeal cancers [1], during which nerve sparing is necessary to preserve function [2]. The internal branch of the superior laryngeal nerve (ibSLN) enters the parietal recess mucosa and is distributed in the submucosa of the larynx and hypopharynx [3]. The ibSLN controls sensory perception. Damage to this may result in loss of the laryngeal cough reflex, resulting in aspiration pneumonia. A previous study reported the efficacy of double-scope ESD (ds-ESD) for laryngeal cancers [4]. We believe that ds-ESD is effective in nerve preservation. Here, we report a case of successful nerve-sparing ESD using the double-scope method.

A 72-year-old man presented with a 25 mm type 0-IIa lesion of the right piriform sinus ([Fig. 1 a]), which was surgically treated under general anesthesia ([Video 1]). During treatment, an otolaryngologist elevated the larynx using a curved laryngoscope (Nagashima Medical Instruments Co., Ltd., Tokyo, Japan) to ensure an adequate working space. Chromoendoscopy with 0.75 % Lugol’s solution clearly revealed the lesion ([Fig. 1 b]), and marking dots were placed around the lesion using a DualKnife J (KD-655Q; Olympus, Tokyo, Japan). Cutting and dissection were performed using a transoral endoscope (GIF-H290T; Olympus). A saline solution was injected into the subepithelium. After the mucosa was cut and the subepithelial layer was dissected to a length of ≥ 5 mm for grasping ([Fig. 2]), appropriate traction was performed using a thin transnasal endoscope (GIF-1200N; Olympus) and grasping forceps (FG-4L-1; Olympus). The traction direction was changed by controlling the angle of the thin endoscope.

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Fig. 1 Endoscopic images. a White-light image of the lesion. A 25 mm type 0-IIa lesion was located at the right piriform sinus. b 0.75 % Lugol chromoendoscopy. The lesion could be seen more clearly than with white-light imaging.

Video 1 Double-scope endoscopic submucosal dissection for superficial laryngeal cancer to preserve the superior laryngeal nerve.


Qualität:
Zoom Image
Fig. 2 Proper traction with a transnasal thin endoscope and a grasping forceps.

Proper traction with ds-ESD allowed visualization of the ibSLN and enabled nerve-sparing ESD ([Fig. 3]). No dysphagia or aspiration pneumonia occurred after ESD.

Zoom Image
Fig. 3 A good view of the internal branch of the superior laryngeal nerve (red arrows) was achieved with the double-scope method.

Endoscopy_UCTN_Code_CCL_1AB_2AB

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Artikel online veröffentlicht:
26. Mai 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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