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Ann Thorac Surg 1997;63:772
© 1997 The Society of Thoracic Surgeons

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Discussion

See also page 768.

DR DANIEL L. MILLER (Louisville, KY):

I enjoyed your presentation. My colleagues and I have been impressed with the use of the LMA for outpatient mediastinoscopy. I have two questions. First, in regard to the leukoplakia found, what was the treatment and the outcome? Second, do you think that the LMA is cost-effective in regard to finding other abnormalities?

DR FERSON:

The finding of abnormal laryngeal lesions in 2 of our patients was unexpected. Head and neck surgical consultations were called intraoperatively. Biopsy specimens were taken and findings revealed leukoplakia in both patients requiring no further intraoperative intervention. The strong association of lung cancer with another primary cancer in the aerodigestive tract is now well established, with the highest incidence of laryngeal cancer. One of the goals of fiberoptic evaluation of upper and lower airway immediately before thoracotomy is to screen for any new abnormal lesions and determine the best surgical and medical management. In contrast to the endotracheal tube, the LMA allows for fiberoptic inspection of the entire airway, providing more accurate evaluation and diagnosis, resulting in more appropriate management. The issue of cost effectiveness can only be speculated about from the optimal medical decisions based on accurate clinical and pathologic evaluation.

DR KENWYN G. NELSON (Tyler, TX):

We have used this also in the face of acute hemoptysis and found this to be very useful from the point of view of determining the origin.

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