ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, March 5, 1996 TAG: 9603050076
SECTION: EXTRA PAGE: 1 EDITION: METRO
DATELINE: ALBANY, N.Y.
SOURCE: MARY ESCH ASSOCIATED PRESS
A red pinpoint of light danced in her throat as Anne Zekoll's tonsils disappeared in a wisp of smoke. Ten minutes later, the teen-ager was ready to go out for ice cream.
``It sounded like Rice Krispies inside my head,'' Zekoll said, smiling. ``You know - snap, crackle, pop.''
That was how she described the surgery she had just undergone at Albany Medical Center Hospital. It was done with a beam of light, a laser, a new and as yet uncommon method for one of the most common of surgical procedures, a tonsillectomy.
And it was done by the physician who developed the new technique, Dr. Yosef P. Krespi, ear, nose and throat surgeon and chief of the Department of Otolaryngology at St. Luke's-Roosevelt Hospital in New York.
Tonsillectomy is prescribed most often for young children with enlarged tonsils that obstruct breathing. This patient, Anne Zekoll, is 17.
The surgery also helps adults whose tonsils have pockets, or crypts, that trap food and bacteria. Cryptic tonsils are the main cause of chronic sore throats and bad breath, said Krespi.
Traditionally, tonsils are removed under general anesthesia in the hospital, with a scalpel or electrocautery tool. Post-operative pain lasts a week or more.
But with new laser equipment, the troublesome tissue on the back wall of the throat can be removed under a local anesthetic in the doctor's office, with no bleeding and little discomfort, Krespi said.
It takes only minutes. The patient can go to work the same day. And the laser procedure costs less than $2,000, said Krespi.
The procedure is called LAST, or Laser-Assisted Serial Tonsillectomy. It's performed using a hand-held device that directs a high-powered laser beam through two rapidly rotating mirrors. The tool was developed about five years ago for throat surgery, Krespi said.
Instead of being sliced or pierced, the tissue is ablated - that is, burned away in precise, thin layers, at such intense heat that the flesh is literally vaporized.
``It's quick and painless,'' said Zekoll. ``Afterward, it's like a mild sore throat for a few days.''
Zekoll's physician referred her to Dr. Joseph Steiniger at Albany Medical Center after recurring strep-throat infections made her miss weeks of school. Steiniger recommended tonsillectomy and gave her the option of hospital surgery or the new laser technique. She chose the latter.
``The usual operation would have kept me home for two weeks [to heal],'' she said. ``I had already missed too much school.''
When Zekoll had her tonsils removed by laser she said the only things she really disliked were the tongue depressor, which sometimes hurt her gums, and the anesthetics - a foul-tasting spray, a thick liquid and several injections.
When her throat was numb, she sat in a high chair beside laser equipment resembling a dentist's setup. Steiniger told her to hold her breath, then went to work with the laser probe on an articulating arm.
There was a sizzling sound as tonsil cells burned and burst. A suction tube whisked away the smoke.
``The reason standard tonsillectomy causes so much pain is that you remove the whole tonsil, leaving exposed pharyngeal muscle,'' Steiniger said. With the laser technique, a thin layer of tissue is left covering the underlying muscle and nerves, he said, so the pain is minimal.
The laser surgery isn't for everyone, however.
Young children and some adults have too strong a gag reflex to tolerate the tongue depressor, even with the local anesthetics, Steiniger said. A few adults can't bear the long needle used to inject Novocain into the throat, which is first numbed with a spray.
And some people just don't want to be awake in a chair while someone vaporizes their tonsils with a laser probe, despite assurance that it will be painless and take only a few minutes, Krespi said.
``I would say 90 percent of people tolerate the procedure,'' he said.
Tonsils are part of the lymphatic system, which fights infections. They're large in 7-year-olds, start shriveling after age 12 and are small in most adults, Krespi said. It's common for adults to have tonsil crypts, he said, but they usually don't cause problems.
Krespi started using a standard laser to remove cryptic tonsils about eight years ago, using general anesthesia in the operating room. The new hand-held laser attachment made the office surgery possible because it was smaller, safer, faster and more precise, he said.
Of the 7,000 to 8,000 ear, nose and throat doctors in North America, about 800 to 1,000 have lasers in their offices, said Krespi, who teaches the new procedure to surgeons.
Not everyone agrees that Krespi's technique is all that great, however.
The LAST was "tried and abandoned" at Lewis-Gale Clinic in Salem, said Dr. Bruce Hagadorn, medical director. It didn't prove to be less painful or less expensive, he said.
Roanoke physician William Dichtel said he still considers the laser tonsillectomy "second best" to a traditional operation. It has become popular mainly because of the availability of laser equipment, he said.
However, Lewis-Gale Clinic physicians and Dr. Dichtel do like another laser procedure, called a LAUP (pronounced lay-up), or Laser-Assisted Uvulopalatoplasty.
A hand-held laser probe is used to trim the uvula, that punching-bag shaped bit of flesh dangling at the back of the mouth, to stop snoring and mild cases of sleep apnea, a serious breathing obstruction.
The LAUP is designed as an office procedure, but rather than invest in laser equipment for their offices, Lewis-Gale physicians do the procedure in the clinic's outpatient surgery. Dichtel has arranged to do his LAUPs at Community Hospital.
It's still an outpatient procedure, requiring about an hour, Dichtel said.
Staff writer Sandra Brown Kelly contributed information to this story.
LENGTH: Long : 109 lines ILLUSTRATION: PHOTO: AP. A patient undergoes a laser tonsillectomy under atby CNBAlbany (N.Y.) Medical Center Hospital. Ten minutes later, the teen
was ready to go out for ice cream. color.