page_title: Endoscopic laser cordectomy
section_title: Procedure
hierarchical_section_title: Endoscopic laser cordectomy / Procedure
caption_attribution_description: English: The image is showing cordotomy incision(grey dotted line) on the posterior part of the right vocal cord.
context_page_description: Endoscopic laser cordectomy, also known as Kashima operation, is an endoscopic laser surgical procedure performed for treating the respiratory difficulty caused as a result of bilateral abductor vocal fold paralysis. Bilateral vocal fold paralysis is basically a result of abnormal nerve input to the laryngeal muscles, resulting in weak or total loss of movement of the laryngeal muscles. Most commonly associated nerve is the vagus nerve or in some cases its distal branch, the recurrent laryngeal nerve. Paralysis of the vocal fold may also result from mechanical breakdown of the cricoarytenoid joint. It was first described in by Kashima in 1989.
context_section_description: Surgery is performed under the effect of general anesthesia. The correct position of the patient is mandatory for the ideal introduction of laryngoscope. Preferably the patient should lie flat on the operating table without any head ring or sand bag beneath the shoulders. Before introduction of the laryngoscope, dental plate should be put in place.  After tracheotomy, with a laser-safe endotracheal tube the patient is intubated with an ample exposition of the glottis. A small laser-protected endotracheal tube is placed in case there is no pre-existing tracheotomy.
  A modification to this technique is made by using endoscopic CO2 laser posterior cordotomy without tracheotomy to not compromise respiration by minimising the postoperative edema. This modified procedure involves a judicious excision of 3.5–4 mm C-shaped wedge in posterior vocal cord from the open edge of the membranous cord using carbon dioxide laser. Excision is made anteriorly to the vocal process, continuing 4 mm laterally on to the ventricular band without exposing the cartilage. A 6–7 mm transverse opening is created at the posterior larynx by the surgical resection. To avoid unwanted effects of general anesthesia and prevent any infection during the operation, antibiotics, steroids, and H2 blockers are administered intraoperatively.
caption: The image is showing cordotomy incision(grey dotted line) on the posterior part of the right vocal cord.
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