Laser applications in laryngology: past, present, and future.

Endolaryngeal surgery has been a primary driver for the development of laryngology since its inception in the mid nineteenth century, and laser technology [1] has been a key element of that development over the past 30 years [2–5]. Endoscopic laryngeal surgery remained office-based despite the transition from indirect-mirror-guided interventions to direct-laryngoscopic (Kirstein 1895) procedures in the early twentieth century [6]. Kirstein [7,8] clearly envisioned the enhanced surgical precision provided by direct laryngoscopy and astutely foretold the changeover to direct endolaryngeal surgery. ‘‘Autoscopy is veritably a surgical method...I nevertheless believe that finally, in the course of years, autoscopy will be generally accepted as the standard method for endolaryngeal and endotracheal surgery’’ [8]. As is often the case, an advance in anesthesia (ie, topical cocaine) [9,10] allowed for surgical development. With the ability to administer effective local anesthesia with cocaine, Kirstein performed autoscopy (direct laryngoscopy) in his office with an assistant. Subsequently, Jackson [11] championed moving direct laryngoscopic surgery to the operating suite as illustrated in the first textbook of rigid endoscopy of the upper aerodigestive tract. Throughout the twentieth century, seminal innovations such as the surgical microscope [12–15] and general endotracheal anesthesia greatly enhanced the precision and success of endolaryngeal surgery. This culminated in the introduction of the carbon dioxide (CO2) laser to surgery in the 1970s by Polanyi [1], Jako [2], Strong [3,16], and Vaughan [5,17]. They coupled the CO2 laser