Georges Lawson

Université Catholique de Louvain, CHU UCL Namur · ENT - H&N Surgery

Trans-oral total laryngectomy (TOTL) is a novel minimally invasive approach to narrow-field laryngectomy. The objective of this study was to review published data on robotic and endoscopic-assisted TOTL to examine oncologic, functional, and adverse outcomes. MEDLINE, Web of Science, and Cochrane databases were searched between January 2009 and Dece...

Background In oral and oropharyngeal squamous cell carcinoma (SCC), sentinel node biopsy (SNB) was described as a reliable and reproductive alternative to elective neck dissection for the staging of clinical N0 T1–T2 patients. The SNB technique in supraglottic laryngeal SCC was successfully described in small series. The aim of this study is to ana...

Background: Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody tar...

Background: Over the past decade, therapeutic options in head and neck supraglottic squamous cell carcinoma have constantly evolved. The classical total laryngectomy has been partially replaced by alternative organ- and function-sparing techniques with the same prognosis but less morbidity, such as Radiotherapy, Transoral Laser Microsurgery (TLM) a...

Tracheotomy is one of the most commonly performed surgical procedures in the critically ill patient with airway obstruction or difficult airway management.It was described and used for airway control and lifesaving treatment for at least 3500 years.The procedure can be performed by various surgical techniques, at the bedside in the intensive care u...

Introduction Flexible platforms for TORS have been utilised for over five years. The aim of this review is to provide a thorough appraisal of the impact of flexible robotic systems in head and neck surgery and laryngology, the advantages and disadvantages compared to other systems, cost and benefits as well as future prospects in the development of...

PurposeWith the development of minimal invasive procedure, trans-oral robotic surgery (TORS) is expanding in the field of ENT. Most reviews focus on oropharyngeal and laryngeal (supra-glottic) localization. We report here the feasibility and outcomes of TORS hypopharyngectomy (TORSH) for selected patients with hypopharyngeal tumor.Methods Between S...

Purpose This prospective, non-randomized, interventional phase I-II study investigated the individualization of the elective node irradiation in clinically N0 (cN0) head and neck squamous cell carcinoma (HSNCC) by sentinel lymph node (SLN) mapping with SPECT/CT and its impact on tumor control and radiation-related toxicity. Materials and methods F...

Objective: The aim of our study is to demonstrate our technique for performing transoral robotic surgical total laryngectomy (TORS-TL) with the use of the da Vinci robotic system. Materials and methods: We provide a comprehensive description of the TORS-TL operative techniques. Two fresh-frozen human cadavers were selected after ethics approval...

Objectives: The surgical management of anterior glottic webs includes both open and closed approaches, both of which do not guarantee complete resolution of the web on all occasions. We present our experience in 11 patients between 2012 and 2015, including using the Lichtenberger endoscopic approach. Methods: We used the Lumenis CO2 laser using the...

Development of a novel computerized acoustic assessment. (Presentation) American Academy of Otolaryngology Annual ENT Expo, Chicago, USA, 2017.

Objectives: To compare a novel computer acoustical software’s (A4S) analysis of laryngectomized valved speech (laryngectomy voice analysis) with that of a team of speech pathologists using the Impression, Intelligibility, Noise, Fluency and Voicing (IINFVo) scale. Methods: This is a prospective single-center observational study over 12 months. A to...

Objective: To determine the etiology and subsequent management of patients with unilateral vocal fold immobility (UVFI) and compare our results with other such studies. Study design: Retrospective case series of all patients treated for UVFI at one single tertiary referral centre between 2010 and 2014. Methods: The medical records of 161 patients o...

Introduction Transoral robotic surgery (TORS) has over the last decade become an integral part of minimally invasive surgery in the head and neck. Over this period, ENT surgeons have adapted the da Vinci robotic system to fulfill unmet needs for access in the oropharynx and tongue base primarily. The larynx has however been more difficult to access...

Vocal fold immobility is a restriction of movement of the vocal folds either by a neuropathic or mechanical cause. Over the past few decades, there has been a shift in the etiology of unilat- eral vocal fold immobility (UVFI) from extralaryngeal malig- nancies to nonthyroid surgical procedures. We present a retrospective review of 161 patients diag...

Head and neck cancer (HNC) is predominantly a locoregional disease. Sentinel lymph node (SLN) biopsy offers a minimally invasive means of accurately staging the neck. Value in healthcare is determined by both outcomes and the costs associated with achieving them. Time-driven activity-based costing (TDABC) may offer more precise estimates of the tru...

Vocal fold immobility is a restriction of movement of the vocal folds either by a neuropathic or mechanical cause. Over the past few decades, there has been a shift in the aetiology of unilateral vocal fold immobility (UVFI) from extra-laryngeal malignancies to non-thyroid surgical procedures. We present a retrospective review of a 161 patients ove...

Transoral robotic surgery (TORS) has steadily developed into a highly specialised area in head and neck surgery with applications predominantly in the oropharynx and tongue base. The larynx has however been a more challenging area using the current robotic technology available. We present three cases using a novel system recently developed to facil...

The da Vinci robotic system in Head and Neck Surgery. Intuitive Surgical Inc. (Sunnyvale, Ca, USA) extended the use of the da Vinci robot to head and neck surgery in 2005 following the previous use in urological, gynecological and cardiothoracic surgery. It then gained wide popularity throughout the globe. Our aim is to describe the da Vinci Robot...

A frequently cited criticism of robotic surgery is the cumbersome nature of setting up the robotic system in operating theatres. This misconception has led many to steer away from developing this new technology even if it likely that it possesses advantages over traditional surgical approaches to the head and neck. Over the last 8 years we have de...

Nous présentons notre expérience du traitement des synéchies antérieures au cours des quatre dernières années avec l'utilisation du stent LACS (Laryngeal Anterior Commissure Stent) . Le LACS ( Boston Medical, USA) est une membrane en silastique de 0.4 mm d'épaisseur avec un renforcement tubulaire pour le passage d'un fil de type monofilament non re...

Robotic-assisted surgery is one of the fastest growing areas of Head and Neck surgery, specifically transoral robotic surgery (TORS) for pharyngeal and laryngeal procedures has shown early and rapid acceptance. While early clinical trials had focused mainly on oropharyngeal tumors [1], technologic advances have improved the reach and access of robo...

The primary objective of this paper is to report our first cases of an ongoing prospective study for assessing the safety and performance of the Medrobotics Flex System for access and visualization of the larynx and the vocal folds when used for transoral surgical treatments.

CO2 laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer. Single center retrospective cohort study. Eleven patients with glottic squamo...

Head and neck surgery can be fraught with difficulties in accessing the pharynx and larynx. Minimally invasive surgery has developed with the recent advances in technology. Currently, we have a variety of high-definition multichannel videoendoscopes and robots in our armamentarium. We present our experience in a new robotic surgical system-'The Med...

Dear Editor, We are writing to convey our sentiments with reference to the article by Schuler et al.1 Although we agree that the authors are possibly the first to have performed transoral robotic surgery on a T2 squamous carcinoma of the oropharynx using the Flex System (Medrobotics Corp., Raynham, MA) as described in their article published in you...

Transoral CO2 laser cordectomy for squamous cell carcinoma (SCC) of the glottis has resulted in excellent voice and oncologic outcomes as compared with non-surgical therapy. However, published experience with primary CO2 laser cordectomy specifically for glottic SCC involving the anterior commissure (AC) is limited. A review of single academic inst...

Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to wh...

Background Clinically node negative HNSCC patients have a risk ranging between 18 and 45% of occult metastases, making prophylactic irradiation mandatory. Selective irradiation of nodal target volume based on international guidelines is practice. Anyway, about half the tumours lying in an anatomical subsite known to potentially drain bilaterally ef...

Recurrent respiratory papillomatosis is a viral-induced disease, associated with exophytic epithelial lesions affecting the upper airways. Problem of treatment is the high recurrence of papilloma growth after surgical removal; therefore, adjuvant therapy schemes have been established. We used cidofovir, 7.5 mg/ml, in adjuvant therapy in the past ye...

Las alteraciones funcionales de la laringe afectan a la respiración, la deglución en su función protectora de las vías respiratorias y la fonación. La función de protección es totalmente refleja e involuntaria, mientras que las funciones respiratoria y fonatoria pueden ser iniciadas voluntariamente pero son reguladas involuntariamente por toda una...

Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whet...

Objectives/hypothesis: To describe a single center outcomes following transoral robotic surgery for supraglottic laryngectomy (TORS-SL). Study design: Prospective data collection. Methods: Patient records receiving TORS-SL for squamous cell carcinoma (SCCA) with at least 12 months follow-up fit inclusion for this study. Two patients with previ...

Transoral robotic surgery (TORS) has expedited patient rehabilitation while maintaining excellent outcomes following oropharyngectomy. The further application of TORS to supraglottic laryngectomy and hypopharyngectomy has been reported with feasibility trials and promising initial data. The combination of the two procedures, supraglottic and hypoph...

This study aimed to evaluate the diagnostic reliability of sentinel lymph node biopsy in patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx by reviewing the published literature. A systematic literature review was performed using MEDLINE from 1970 to 2011. With Boolean search strings, search terms included...

Endoscopic cricopharyngeal myotomy (ECPM) with CO(2) laser is indicated in cases with swallowing disorders when a dysfunction of the cricopharyngeal muscle is diagnosed. We present the results of a retrospective study including 32 of the 65 consecutive patients who underwent ECPM in our center between 2002 and 2009. The aim of this study is to eval...

The fourth branchial cleft fistula, which can be the origin of a recurrent left neck abscess, is a rare congenital malformation. Its diagnosis can be difficult. A ten-year-old girl presented with a left painful swelling of the neck. At ultrasonography and tomodensitometry, the diagnosis of thyroglossal cyst was suspected. Antibiotics were prescribe...

Objective: To date no clinical investigations have reported on the coagulation effects of flexible fiber CO2 laser delivery to head and neck tissue, the results of which have a direct impact for the progression of transoral laser microsurgery. The objective of the present study was to investigate the histopathologic thermal effects of a flexible fi...

Anterior glottic webs are most frequently acquired and result in a major vocal handicap. Many treatment modalities have been reported in the literature. None of them achieves perfect morphological or functional results. We present our series treated by an endoscopic technique based on CO(2) laser section of the web, mitomycin application and placem...

The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease We studied the patterns of care in the French-Belgian Groupe d'Etude des Tu...

It is hypothesized that real time objective measurement of the subglottic pressure could contribute to the choice of the implant’s size (IS) in medialization thyroplasty (MT). A prospective study was conducted with patients with glottal insufficiency. Patients had a MT using a Montgomery implant® (Boston medical, Boston, USA). Peak direct subglotti...

Objective Transoral laser microsurgery (TLM) for endoscopic excision of head and neck cancers of the upper aerodigestive tract has become an accepted treatment modality. As in any excision of head and neck tumors, the persistance of tumor at the surgical margins influences the outcome. One of the frequent criticisms of endoscopic resection is that...

We present a series of patients treated by transoral robotic surgery (TORS) using a new CO(2) laser wave guide (CO(2) LWG) (Lumenis, Santa Clara, CA). Patients older than 18 years, with malignant pharyngo-laryngeal tumors were enrolled in this prospective study after signing an informed consent. Four patients were enrolled in the study. The mean ag...

We present the first series of patients treated by transoral laser surgery (TLS) using the new AcuPulse 40WG CO(2) laser with the FiberLase flexible waveguide (CO(2) LWG) (Lumenis, Santa Clara, CA) with the objective to test its reliability and efficacy. Patients older than 18 years, with oral, pharyngo-laryngeal or tracheal benign or premalignant...

Transoral CO2 laser microsurgery is gaining ground at the expense of external approaches in the management of laryngeal tumors. Endoscopic surgical indications depend on the location, extension, and accessibility of the tumor as well as the surgeon's expertise. The status of surgical margins is a very important prognostic factor. One of the major c...

Sulcus vocalis is one of the most difficult benign laryngeal lesions to manage. This article describes the authors' technique for treatment of sulcus vocalis using the CO2 laser digital scanning system and injectable collagen. The aim of this surgery is to increase the pliability of the vocal folds and decrease the glottal gap. The surgical techniq...

Transoral robotic surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The objective of this study is to describe our first steps and present our experience on the technical feasibility, safety, and efficacy of TORS for the treatment of selected malignant lesions. From April 2008 to September 2009, 24 patients were enr...

The prognosis of cancer patients is highly dependent on the time of diagnosis. Early, stage 1 disease is often curable whereas late stage diseases are usually beyond curable treatments. Therefore, new diagnostic tools for malignancies of the upper aerodigestive tract are developed all the time and narrow band imaging (NBI) is one of these new optio...

Microsurgery for intracordal cysts is a challenging procedure, because cysts are close to the vocal ligament and the risk of inducing a scar is high. In this retrospective study, our experience with the CO(2)-laser scanning system (Acublade(®)) is reported on 49 patients. There were 41% epidermoid cysts and 59% mucous retention cysts. A quarter of...

Problem/objective: Kaposi sarcoma is the most frequently-occurring neoplasm in AIDS patients. Laryngeal localization is infrequent. We discuss the management options for laryngeal Kaposi sarcoma based on a literature review. Case report: A 42 year old, HIV-positive male receiving HAART therapy presented with mild hoarseness and sore throat. Fibe...

To study the reliability of the sentinel node technique (SNT) in the management of the N0 neck in patients with supraglottic laryngeal cancer. Patients presenting to our department, between 2001 and 2004, with T1-T3 supraglottic cancer and N0 neck, clinically and radiologically, were included in the study. All patients underwent sentinel lymph node...

Vocal fold scars are the result of injury to the vocal fold lamina propria. This condition leads to an impaired vibration and usually to poor voice quality. The purpose of our study was to compare the pre- and posttreatment voice assessment scores in patients treated by CO(2) laser-assisted freeing of the scar followed by collagen injection. A grou...

The aim of this study was to evaluate the objective voice results of Wendler's glottoplasty in male-to-female transsexuals. We retrospectively reviewed our patients treated with Wendler's technique with minor modifications. Glottoplasty consisted in CO(2)-laser epithelial ablation of the anterior commissure and the two vocal folds in anterior third...

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty w...

Objective: Report a new technique of laser-assisted uvulopalatoplasty (LAUP) for snoring performed as a one-stage procedure. Study Design: A decision-tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Midler's maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the...

The aim of this study was to evaluate long-term results of endoscopic surgery for supraglottic carcinoma. Case series with chart review. Tertiary care university hospital. From 1992 to 2004, 45 patients diagnosed with supraglottic squamous cell carcinoma (two Tis, nine T1N0, 27 T2N0, two T2N1, one T2N2, four T3N0) underwent different types of endos...

When acute massive pulmonary embolism is life threatening, thrombolysis could be a therapeutic option. However, lysis may be contraindicated once the risk of bleeding is high. We report on two patients who have massive pulmonary emboli complicated by severe hypotension, justifying thrombolytic treatment. Nevertheless, recent surgery in the first pa...

Endoscopic resection of laryngeal tumors is replacing external approaches. One drawback of endoscopic resection is the difficulty of interpretation of histological specimens because of thermal effect of laser on tissues. Our goal is to assess the reliability of frozen section in this setting by comparing its results with those of routine histology....

To analyze the impact of positron emission tomography with fluorodeoxyglucose (FDG-PET) in the treatment of patients suspected of having head and neck cancer recurrence. Prospective and consecutive inclusion of 44 patients presenting with clinical symptoms suggestive of head and neck tumor recurrence. FDG-PET was compared with combined computed tom...

Report a case of a patient, who benefitted from the I-gel, during an elective urological surgery and who presented severe laryngeal hemorrhage at the time of its withdrawal. A 71-year-old male patient had been admitted in the operating room for the insertion of a ureteral stent. He had a history of usual interstitial pneumonia (UIP) requiring corti...

Poster

Le reflux pharyngo-laryngé (RPL) est actuellement largement mis en cause dans les pathologies laryngées. Le diagnostic et le traitement, calqués sur les méthodes appliquées au reflux gastro-œsophagien, rencontrent de nombreux échecs. Depuis peu, plusieurs auteurs tentent de mettre en évidence les mécanismes d’action propres du RPL au niveau molécul...

Laryngopharyngeal (LPR) reflux, i.e. over the superior oesophageal sphincter induces severe symptoms resulting possibly from aggression of gastro-oesophageal liquid in the LP area. A relationship between symptoms and described lesions is difficult to demonstrate. These lesions can be related to other etiologic factors (posterior chronic rhinorrhea,...

Le reflux pharyngo-laryngé (RPL) en amont du sphincter proximal provoque de nombreux symptômes, témoins possibles d'une agression acide dans l'aire supraglottique. La relation entre ces symptômes et les lésions de la sphère ORL sont difficiles à établir. La présente revue les considère sous deux aspects: 1) la laryngite postérieure couramment décri...

Objective The aim of this study was to evaluate long-term results of transoral CO2 laser-assisted surgery for supraglottic carcinoma. Methods From 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent differen...

The development of the scanning system AcuBlade has considerably enhanced carbon dioxide laser energy delivery, improving cutting and ablation modes. The scanning system can be applied with the 2 available high-powered pulsed waves, SuperPulse and UltraPulse. This study was conducted to determine whether there are any differences in phonosurgery be...

A prospective study was designed to compare two single-dilator percutaneous tracheotomy techniques, the Ciaglia BlueRhino and the Percutwist technique. One hundred and ninety adult patients were included, 166 with the BlueRhino, a conical shaped, flexible rubber dilator, and 24 with the Percutwist, a screw like dilating device. The procedure was pe...

Today, laryngopharyngeal reflux (LPR) is widely considered as a major cause of laryngeal diseases. Diagnosis and treatment based on the methods used for gastroesophageal reflux disease (GERD) frequently prove to be inefficient. Recently, some authors have been focusing on the specific molecular etiopathology of LPR. They have discovered the presenc...

Our objective was to introduce a new technique for cricoid cartilage reconstruction. A 74-year-old male patient with a history of a 6-month progressively worsening dyspnea was found to have an extensive mass of the left cricoid cartilage. Although the extent of his disease would necessitate total laryngectomy, the patient underwent an open extended...

This review outlines the indications, surgical techniques and follow-up, with results, for current collagen use. Micronized AlloDerm (Cymetra) is a presently available injectable substance made from human collagen and elastin particles. A mean follow-up of 8-10.5 months showed lasting results after injection for vocal fold immobility. Collagen inje...

Compared to herpes zoster oticus, varicella zoster virus (VZV) reactivations in immunocompetent patients are rare in laryngeal region. Usually, associated vocal cord paralyses are reported. Herein is a case report of a patient with laryngeal zoster without any associated motor disorders. An attempt is made to assign the distribution of mucosal erup...

Physical and clinical evaluations are part of the assessment of sleep apnea-hypopnea syndrome (SAHS) and contribute to the therapeutic decision. Sleep-disordered breathing (SDB) can originate from diff erent segments of the upper airway; therefore, the entire upper airway must be examined during evaluation [32]. This must be performed before polyso...