PORTLAND, OR – Today I released a thought provoking video on an idealized "nanomargin" surgical approach for vocal cord tumor management. The video available on YouTube, suggests a paradigm shift from traditional cordectomy protocols established in the 1990s. (Remacle, M., et al. (2000). "Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society." Eur Arch Otorhinolaryngol 257(4): 227–231.)
Altered Approach Preserving More Voice Function
This proposed nanomargin technique challenges a conventional wisdom of taking “wide” surgical margins around vocal cord tumors. I propose, "Any normal tissue that we take out is essentially wasted anatomy and function. The reason behind taking out normal tissue is that surgeons feel they are at high risk for leaving residual tumor in the past."
I’ve thought constantly about the dramatic improvements in endoscopic technology since the landmark 1999 research that established current European laryngeal surgical protocols. Modern high-definition chip endoscopes, selective color imaging (including narrow band imaging), digital recording capabilities, and artificial intelligence enhancement tools now allow surgeons to identify tumor margins with increasing precision.
Key Innovations: "Orange Peel" Surgery Technique
Rather than performing deep cordectomies that remove healthy vocal cord tissue, I propose a type of precision technique I coin "orange peel surgery" – carefully peeling tumor tissue from the underlying healthy structures using programmable CO2 laser technology. The method relies on the differential heat absorption between tumor and normal tissue to guide surgical decisions in real-time.
New Blue Laser technology offers quick, early office-based treatment of suspicious epithelial changes after the initial surgical excision, offering significant time and cost savings for everyone.
Intensive Follow-Up Protocol Replaces Traditional Margins
Central to the nanomargin approach is an intensive surveillance protocol featuring frequent endoscopic examinations and immediate office-based laser treatment of any suspicious findings. "My photo exam is my frozen section margin," I state in the video, emphasizing how advanced endoscopic visualization has replaced traditional pathological margin assessment for myself.
Detailed case studies span multiple years, demonstrating successful and non-successful tumor management while preserving voice quality – potentially achieving outcomes comparable to radiation therapy without the associated long-term complications.
Educational Impact for Next Generation
I specifically address young surgeons in the video, encouraging them to think different and consider how technological advances could inform surgical decision-making. "I propose, ‘Why should we think differently than what we've been taught over the years?’" to challenge viewers.
The presentation includes high-definition surgical footage, endoscopic examinations, and detailed analysis of vascular patterns that distinguish tumor from normal tissue – providing invaluable educational content for laryngology residents and practicing surgeons.
Clinical Implications
The nanomargin approach represents a potential paradigm shift from tumor "cure" to tumor "management," as I advocate long-term surveillance rather than the traditional five-year follow-up window. Patients who undergo this technique initially require monthly visits and tolerance for frequent endoscopic examinations, but may achieve superior functional outcomes.
About me: I’ve studied the human voice for 30+ years, travel and lecture frequently on vocal cord diagnosis by listening, visual identification of neurolaryngeal impairments and gender voice surgery. I maintain an active educational practice with frequent worldwide visitors and offer a laryngology fellowship. My thoughts are available at voicedoctor.net.
Video Access
The complete educational presentation is available on YouTube at: https://youtu.be/pKKMbOoXSPs
Note to Editors: Dr. Thomas emphasizes that this technique requires specialized training and patient consent, as it represents a departure from standard protocols. The video is intended for educational purposes and professional medical audiences.
This press release announces educational content and does not constitute medical advice. Patients should consult with qualified laryngologists regarding individual treatment decisions.