External Pressure During Microlaryngeal Surgery – A New Device For Improved Visualization

<h2>SUMMARY</h2><h3>Objective</h3> To investigate the need for external laryngeal counter pressure during microlaryngeal surgery (MLS) and to present a new device that can be used for improved visualization of the larynx during surgery. <h3>Methods</h3> Patients who underwent MLS due to vocal fold pathology at Karolinska University Hospital in Sweden between January 1st, 2018, and December 31st, 2019, were retrospectively identified by their surgical classification code in the patient charts. Data regarding gender, age, diagnosis, the need for external pressure to the larynx, and complications were noted. A new innovative laryngoscope holder was created and produced in collaboration with the medical technology department at the Karolinska University Hospital. <h3>Results</h3> Among 452 surgical procedures in 382 individuals, external laryngeal pressure was needed in 34% of the cases to receive adequate exposure of the larynx. External pressure was more frequently needed among male patients (<i>P</i> = 0.007). Neither the location of the lesion on the vocal fold nor whether it was malignant or benign was significantly important (<i>P</i> = 0.798 and <i>P</i> = 0.073, respectively). A new laryngoscope holder is presented, which can provide stable external pressure on the laryngeal framework during MLS. <h3>Conclusion</h3> External laryngeal pressure was needed in 34% of the cases for full laryngeal exposure during MLS. To facilitate external pressure of the larynx during surgery, we present an innovative, adjustable laryngoscope holder that can be used in the laryngoscopy setting for improved visualization of the vocal folds. The device will be further investigated in prospective studies. <h3>Level of evidence</h3> 3