Surgical technique (Kashima’s procedure)
bipolar laryngeal cautery, bleeding
BLEEDING
After the cricoarytenoid joints were palpated intraoperatively, the optimal side for cordotomy was decided upon based on the side with the least range of motion. Surgeon preference was considered if there was no difference between the two sides. Under general anesthesia, the procedure was conducted, and either a tracheostomy tube or a small endotracheal tube (5 or 5.5 microlaryngeal tube) was used to maintain the airway.The glottic gap was opened with the use of a Kleinsasser laryngoscope. At the back of the membranous vocal fold, a transverse incision was created. With the frequency set to 4 MHz and the passive electrode applied to the shoulder region, the incision in group (A) was made using an Ellman Radiosurgical Instrument adjusted in the partially rectified mode (50 percent cut, 50 percent coagulation), with the frequency setting. A specially designed needle electrode was used to make the incision. An Arthro Care ENT Coblator was used to make the incision in group (B) to resect soft tissue. Both cauterization and coblation were employed as settings. The suggested settings for a laryngeal wand were Cauterization—3 (non-plasma setting) and Coblation—7 (plasma setting). PROcise LW was employed by the coblation wand. The shaft could be bent. It was equipped with a screen electrode that could quickly debulk the target tissue. Its flexible shaft conformed to the anatomy of the patient.The vocal ligament and the muscle fibers of the thyroarytenoid muscle were completely divided, and the incision continued laterally until it reached the inner perichondrium of the thyroid cartilage. The incision started anterior to the vocal process of the arytenoid cartilage without exposing the cartilage. Since the electrode moved slowly, the cutting was accomplished by the electrode’s energy effect rather than the surgeon’s physical strength. If bleeding occurred, it was stopped by suction diathermy and bipolar laryngeal cautery or by exerting pressure with gauze soaked with adrenaline (1:1000).