The KTP laser is a highly effective tool that can be used in the operating room. Due to its unique interaction with microcirculation and blood, it is a highly effective tool in treating laryngeal papilloma, pre-cancerous lesions (dysplasia and keratosis), ectasias and vascular malformations and larynx cancer. In all these conditions the laser is able to ablate the abnormal tissue and under the high-powered surgical microscope Dr Broadhurst can visualise when the abnormal tissue is fully removed down to the interface with normal tissue. The KTP laser is also able to remove the feeding microcirculation of these lesions around the periphery, further improving its ability to reduce recurrence.
In the setting of laryngeal papilloma there is a substantially reduced recurrence rate with KTP laser treatment, particularly when coupled with Avastin injections. Dr Broadhurst’s aim in treating laryngeal papilloma is the first treatment to be done in the operation room under general anaesthetic. This provides the most maximal control of the disease. Subsequent to that the majority of patients never return to the operating room and have any subsequent treatment carried out in the office setting as an awake, unsedated procedure. This is a dramatic change from the more traditional treatment approach throughout Australia, which involves all treatments to be performed under general anaesthetic in theatre. In this setting the disease is allowed to progress until it is substantial enough to warrant general anaesthetic and the admission to hospital. Unfortunately, this leads to many patients having significantly prolonged periods of hoarseness while awaiting enough disease to develop to warrant the general anaesthetic and admission to hospital. It is also well established that such treatments with the CO2 laser or microdebrider shaving technique can remove portions of the superficial lamina propria, causing permanent hoarseness.
The ability of the KTP laser not to interfere with or scar the superficial lamina propria layer means a substantially better voice outcome. The majority of Dr Broadhurst’s patients have substantially better voice quality than those utilising other techniques other than KTP laser. For Dr Broadhurst’s patients who have not had any treatment prior to KTP laser, their voices remain entirely normal between episodes.
The KTP laser is also highly effective for early glottic cancer. There are a number of reports now indicating that KTP laser treatment of early glottic cancer is at least as effective as the other current, more substantiated techniques, which include external beam radiation and CO2 laser microsurgery. In Dr Broadhurst’s experience of over 60 cases, the KTP laser has comparable cure and disease control rates in early glottic cancer compared to CO2 laser or radiotherapy treatment results. The main difference however is there is a minimal removal of surrounding normal tissue as the KTP laser provides the ability for ultra narrow margins.
By avoiding excessive resections that would be required with CO2 laser, the KTP laser can minimise normal tissue removal, which maximises the voice outcome following surgery. There are a substantial number of Dr Broadhurst’s early glottic cancer patients that after treatment of an extensive lesion have entirely normal voice many years down the track.
The results on voice outcomes for KTP laser treatment for early glottic cancer were presented in Cairns, Queensland - July 2015 at a world congress on larynx cancer by Dr Broadhurst, who was an invited guest speaker.