Ahmed M. S. Soliman, MD, Professor & Interim Chair as well as Director, Voice, Airway, & Swallowing Center, Department of Otolaryngology, Head & Neck Surgery of The Lewis Katz School of Medicine at Temple University.
Interview conducted by Ivanhoe Broadcast News in November 2017.
This KTP laser that you did on Tom, you did this in stages, it is precancerous but you still staged it, can you explain to us why you did that?
Dr. Soliman: Well the pattern of disease that Tom had involved both vocal folds near the front where both vocal folds come very close together. If I were to do it all at one time he would run a risk of getting a scar banded in the front so I did most of it and only one side in the front and then came back and cleaned up the other side on the left.
Now I know he was a smoker does that have anything to do this or is there?
Dr. Soliman: Yes certainly, smoking is the biggest risk factor for getting cancer of the vocal folds, although his was not really a cancer; it was a pre-cancer; smoking is still the biggest risk factor for that.
And he presented with hoarseness, I think people sometimes like I am getting hoarse and you do not even think about it, it is drainage, it is you know whatever. So what motivated him to feel strongly enough about it to come and see you?
Dr. Soliman: Well I think certainly being a smoker he was concerned and the hoarseness lasted. I mean you can be hoarse for a week or a few days, even a couple of weeks and it can be something minor; most of the time it is; rarely you know do we have cancers, but when the hoariness persist beyond a couple of weeks you know, two to four weeks certainly it needs to be evaluated.
So how do you first diagnose this when comes in, do you do an exploratory down his?
Dr. Soliman: We did a laryngoscopy, so that is an exam, an endoscopic exam of the larynx, so we use a thin fiber optic scope, which we passed through his nose and we are able to get a good view of the entire pharynx and larynx.
And in the scheme of things how bad was his situation?
Dr. Soliman: Tom had a pretty diffuse disease, with lesions on both sides of the vocal folds, in front, the back, and on both sides, it was still superficial in fact early on one thought I had was maybe could this be a fungal infection, because he used to use inhalers and still does, asthma steroid inhalers, which can give that picture, but because the fact he was a smoker and they did not clear up very quickly at all I decided to do a biopsy.
So how direct and how positive is this KTP laser comparative speaking with say with an older technique?
Dr. Soliman: The KTP laser has a lot of advantages, the biggest advantage is that its wave length is very much that of red blood cells so the hemoglobin within red blood cells, which is in blood vessels. Tumors have a very robust blood supply and so the laser is able to target those blood vessels and choke off the blood supply to the tumor.
What did you use to do prior to the KTP?
Dr. Soliman: We could remove these with cold instruments and a long scalpels, elevators, scissors; and you can certainly still do that if it was a single lesion it could be done that way but because of how diffuse his disease was I think that would require stripping most of the lining off both sides; which would have left him with a lot of scarring and a terrible voice. Some people still use the carbon dioxide laser, it is a different kind of laser which is absorbed by water not the blood vessels, so that again can ablate the tumor, it can remove it but will result in a lot of scarring as well. And radiation although again in his case it was precancerous so there would have very aggressive, but for example, if we had gone in and removed it a couple of times and it kept coming back, radiation may have been an option as well.
How long has it been around and describe briefly what the actually surgery is like and how you perform the surgery?
Dr. Soliman: The KTP laser has actually been around for quite a long time. Lasers in general were first described for medical use in the 1960’s, the KTP has been around probably at least since then. It really became quite popular about a decade ago in its pulsed format; rather than provide a continuous beam of energy, it is pulsed, so it allows time in between for the tissue to cool down. The way we did the surgery is basically the first time we did it was under anesthesia, so after we put him to sleep I placed a scope through his mouth and was able to visualize the larynx and using the microscope I was able to use a fiber to deliver the KTP laser down to the vocal folds where the lesions were, and to remove them.
And you are doing this all by camera when you are looking on a screen as you are doing it correct?
Dr. Soliman: Yes, there are actually multiple screens or we look directly into the microscope.
Which is easier for you to do?
Dr. Soliman: Looking in through the microscope stills will give you better depth perception then up on a screen although that is improving all the time in the screens; they are a 3D monitors that are on the horizon. Most people operate still through the microscope for this kind of work.
And the pulsing is that easier for you to be very defined and specific on what you are hitting as it cools down?
Dr. Soliman: The fibers are very, very thin down literally to less than a millimeter, so you could have a really focus beam when you are removing these tumors.
So how did Tom do after his surgery and how is he doing now?
Dr. Soliman: Tom has done great. He required two surgeries and final touch up, again because of how diffuse his disease was. So we did the first surgery, he recovered for a few weeks and then about a month later we took back and removed the rest, and then a few months later we went back and did just a little touch up that was actually done awake with him through a little fiber scope through his nose; and he has been doing great; he is two years out now he has no evidence of the disease of recurrent disease and his voice is still wonderful; he is enjoying retirement.
How often does the KTP laser procedure work this well, as it did in Tom’s case?
Dr. Soliman: You know the KTP laser works very, very well for superficial lesions very much like Tom. For disease on the surface and it works very well. His also had a very well defined blood supply, which the laser really focuses right in on and concentrates that energy to remove it. If it was a larger or a more invasive tumor, the KTP would not work as well.
How often do you do these surgeries and is this the primary bulk of what you do?
Dr. Soliman: It is a good bit of what I do, I am probably doing at least one a week or so, and several per month. I focused my practice primarily on laryngeal disorders, vocal folds disorders, airway disorders and I use lasers pretty widely, KTP for tumors like Tom’s, the carbon dioxide, which we use for scarring and stenosis in the airway primarily.
And how much better is he since he has had the surgery done?
Dr. Soliman: I think he is very happy, I think he will tell you himself; his voice is great; he is able to travel, and enjoy his retirement and again he is free of any tumor.
Other than hoarseness is there anything that people should look at out for in case they are having this happen to them?
Dr. Soliman: Certainly pain, coughing up blood, trouble swallowing, trouble breathing those are all worrisome signs, and they should be evaluated quickly.
If this had progressed to actual cancer what type of cancer would you have turned it?
Dr. Soliman: Squamous cell carcinoma. That is the most common cancer that affects the vocal folds and what he had was basically a high grade dysplasia, severe dysplasia, which is sort of just one step short of invasive squamous cell carcinoma.
And the last question would be without the KTP laser how much more difficult would it be to precisely treat people with the dysplasia and not actual cancer?
Dr. Soliman: It is not necessarily more difficult technically; I think that the outcomes would not be quite as good. The voice would not have been as good.
It sounds pretty cool. So you have been doing this how many years actually with KTP?
Dr. Soliman: KTP for almost three years.
What has been ground breaking about it over the past couple of years or so, or has it been about the same?
Dr. Soliman: I think the tool itself has not changed dramatically, I think what is wonderful are the outcomes; the the linings of the vocal fold is not significantly damaged so it continues to vibrate well and the voice outcomes are excellent.
So as I am looking at that picture you can turn it around obviously it is coming in to that v those are the actual cords?
Dr. Soliman: We call them folds. Cords is kind of the older term but we call them vocal folds now.
So he was taking the inhaled steroid type is that bad for stuff like this?
Dr. Soliman: Well it is bad for voice in general; we have people that come in with dysphonia, with hoarseness from using that alone.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Ahmed Soliman
Jeremy Walter
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
