Trans-oral laser surgery
What is trans-oral laser surgery and why do I need this operation?
Trans-oral laser surgery is removing the tumour by using a beam of light; it can be used in
different ways as a surgical tool. The laser is attached to a microscope to remove tissue instead
of using a scalpel.
The operation will be performed through the mouth (trans-oral) via a microscope, which means
there will be no external cuts or scars after the operation (unless an additional procedure such
as a neck dissection is required).
What are the benefits of having trans-oral laser surgery?
The benefits of having Trans-oral surgery are:
•
Having the surgery will enable the surgeon to remove any visible cancer. By using the
microscope the surgeon is able to see and remove more of the tumour than with the
naked eye.
•
Having a definitive diagnosis will provide information, should you require further
treatment. The removed tissue is sent to the laboratory for analysis. This will provide
information as to whether any further treatment is necessary.
What are the risks, consequences and alternatives associated with having
trans-oral laser surgery?
Most operations are straightforward; however, as with any surgical procedure there is a small
chance of side-effects or complications such as:
•
Bleeding.
•
Infection.
•
Short or long term voice change.
•
Swallowing may be affected, and you may have difficulty in eating and drinking.
Providing the tumour is only in the voice box, this will recover.
•
Due to the nature of the surgery you may get swelling of the tissues inside the throat, and
you may require a tracheostomy to prevent any breathing difficulties. A tracheostomy is a
hole in the windpipe (trachea) to help you breathe. It is usually temporary and will be
removed as your condition improves.
If you are concerned about any of these risks, or have any further queries, please speak to your
consultant.
Your consultant has recommended this procedure as being the best option. However, the
alternative to this procedure is radiotherapy or open surgery. If you would like more information
speak to your consultant or one of our Head and Neck Nurse Specialists. There is also the
option of not receiving any treatment at all. The consequences of not receiving any treatment
are that the tumour will continue to grow locally, with a risk of spreading to the neck and chest.
Further growth will result in your symptoms becoming worse. If you would like more information
please speak to your consultant or one of our Head and Neck Nurse Specialists.
Getting ready for the operation
You will be asked to attend the pre-operative assessment clinic. A nurse will discuss the
operation with you. You may need to undergo some routine tests before your operation eg.
heart trace (ECG), x-ray, and blood tests. These tests are to ensure you are fit enough to have
the operation.
You may be anxious about coming into hospital and have questions that need answering.
Please write down any questions that you feel need addressing and bring them with you when
you come to hospital. The nurses will be happy to answer them or will find out the information
you need.
You will be asked some routine questions about your general health, including whether you
drink or smoke, any allergies you may have and any medicines you take at the moment. It
would be helpful if you bring your tablets with you. The nurse will need to know their name and
strength. This includes non-prescription medicines and complementary herbal/medicines.
You will need to stop taking Aspirin 2 weeks before your surgery.
Please inform the doctor or nurse if you are taking Warfarin or Clopidrogel (these are
anti-clotting agents that make bleeding a higher risk).
If you have a number of illnesses (which places you at a higher risk for an anaesthetic) you may
have a referral to an anaesthetist before your surgery.
You will be asked not to have anything to eat, chew or smoke for at least 6 hours before your
operation. You should have nothing to drink for 3 hours before surgery. You will be advised of
the actual times.
On admission
You will be admitted to the hospital either the day before or on the day of the operation. You will
be advised of this. When you arrive on the ward you will be introduced to the staff and shown to
your bed. Your details (name, date of birth etc) will be checked on a number of occasions
before the operation. This is normal practice and is for your safety. You will be given a
wristband to wear.
You will be asked to sign a consent form to say that you understand what you have come into
hospital for and what the operation involves.
On the day of your operation you will be given a gown to wear. You will be given the choice of
walking to the anaesthetic room or alternatively you could be taken in a wheelchair if you wish.
What sort of anaesthetic will I have?
Your operation will be carried out under a general anaesthetic, which means you will be asleep
throughout. The anaesthetist will visit you before your operation to discuss the anaesthetic with
you.
What should I expect after the operation?
When the operation is over you may spend one or two nights in the Step Down Unit, where you
will have your own nurse and will be monitored closely. You will return to the ward when your
doctor is happy with your progress.
It is usual to feel drowsy for several hours. You will be given oxygen through a mask normally
via a facemask except if you have a tracheostomy then it will be by a mask over your
tracheostomy site.
You will have a drip running into a vein; this is to give you fluids and medication.
Pain relief
Immediately after the operation you may not feel much pain because the laser seals off nerves
so they feel numb. It can then take 2 - 3 days for the feeling to return. Once the feeling returns
you may experience pain; it is important to tell the nurses who can give you painkillers to help.
Mobilising
Within the first few days, you will be encouraged to get up and move around. It is important
mobilise as soon as possible after an operation to reduce the risk of blood clots.
Eating, drinking and speech
If your swallowing is affected, the Speech and Swallowing Therapist will give you advice about
the safest and easiest foods and drinks to take, and the most effective way of swallowing.
The Speech and Swallowing Therapist will see you throughout your care on the ward, as an
outpatient and in the Head and Neck Clinic.
The Speech and Swallowing Therapist will also provide strategies, advice, and swallowing and
vocal exercises to enhance your recovery. You will receive written information from the Speech
and Swallowing Therapist.
If your swallowing is affected by your surgery you may require a feeding tube to support your
nutritional requirements whilst you undergo your surgery and recovery. This will be either by a
nasogastric (NG) tube that is passed via your nose into the stomach or, by a PEG
(Percutaneous Endoscopic Gastrostomy), tube which is passed through the wall of the
abdomen directly into the stomach.
The dietitian will explain in more detail and you will receive written information.
Going home
You will be hospital for 4 - 5 days.
DISCHARGE INFORMATION AND AT HOME ADVICE
Nasogastric tube/PEG care
If you have to go home with a feeding tube you will be advised on how to care for it.
Speech Therapy Outreach Service
Speech Therapy offers a home visit, if required, soon after you leave hospital to review your
eating and drinking recovery. If you require this appointment, it will be discussed and arranged
before you leave hospital.
Personal hygiene
You may bathe or shower as normal.
Pain relief
It is usual to feel pain after this operation. Take the painkillers you were given from the hospital
or a mild painkiller such as Paracetamol - follow the manufacturer’s instructions and do not
exceed the stated dose.
Time off work
For the first 7 days you will be able to certify yourself. Your doctor will discuss with you how long
you will need to be off work. If you need a certificate (sick note) for further time off please ask.
Returning to normal activities
You can return to your normal activities as you feel able. It is usual to feel more tired after
surgery, so rest if you need to.
Driving
Do not drive until you can wear a seat belt comfortably and feel able to perform an emergency
stop. Your insurance company may refuse to meet a claim if they feel you have driven too soon.
It is also advisable to contact your insurance company with regards to cover following a general
anaesthetic.
Further outpatient appointments
An appointment will be sent to you for approximately 4 - 6 weeks and if you are not given a date
before you leave the hospital one will be posted to you.
Useful websites
www.patient.co.uk
www.cancerhelp.org
www.cancerbackup.org.uk
We hope your recovery is speedy and uneventful.
If you have any problems please contact your GP.
If you have any queries or require further information please contact the
Head and Neck Outpatients on 01332 787472, Monday to Friday, 9.00am - 5.00pm.
After 5.00pm and at weekends contact Ward 307 on 01332 787307
Head and Neck Nurse Specialists on 01332 787914 or 783192
Monday to Friday 9.00am - 5.00pm
NHS Direct is a 24 hour nurse led, confidential service providing
general health care advice and information.
Telephone 0845 4647 or visit the website at www.nhsdirect.nhs.uk
Any external organisations and websites included here do not necessarily reflect the views of the Derby Hospitals NHS
Foundation Trust, nor does their inclusion constitute a recommendation.
Reference Code: P0586/1454/02.2010/VERSION2
© Copyright 2010 All rights reserved. No part of this publication may be reproduced in any form or by any means without prior
permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust. (P0067/11.2007/V1)