New Metal Shield for the Endotracheal Tube during Laser Endolaryngeal Surgery

Introduction: To present and assess a newly designed autoclavable, reusable tube shield for an endotracheal tube (ETT) during laser laryngeal surgery.   Materials and Methods: This study included patients scheduled for endolaryngeal laser surgery. A carbonated stainless-steel hemisphere shield (~1.5×0.6 mm) connected to a silk thread passing through a hole in its middle near upper edge was used. Under general anesthesia, patients were intubated orally using a small cuffed polyvinyl ETT, filling the cuff with saline. When the laser was used, the shield was applied either to the side of the tube or anterior to it, depending on the site of the laser procedure. The shield could easily be repositioned when needed during surgery.   Results: In 25 cases (six cordectomy for glottic carcinomas and 19 posterior cordotomy for bilateral vocal cord paralysis), application of the shield over the ETT was easy and the shield could be easily and simply fitted in all cases, with change in position achieved easily during the work as required. The shield over the ETT could not be penetrated by the laser, regardless of the gas composition or laser energy. No intraoperative complications were encountered in any of our cases. Recovery was event-free in all patients without the need for admission to an intensive care unit.   Conclusion: The newly designed autoclavable reusable stainless-steel shield designed for an ETT could be safely, easily, and effectively used during laser laryngeal surgery with low cost and easy availability. However, comparative and multicenter studies are still needed.