Zapping Tonsils: The Patient Still Gets Ice Cream

------------------------------------------------------------------ A BEAM OF LIGHT, a laser,is used for a new method of throat surgery. It's quick, cheap and painless. ------------------------------------------------------------------

ALBANY, N.Y. - A red pinpoint of light danced in her throat as Anne Zekoll's tonsils disappeared in a wisp of smoke. Ten minutes later, the teenager 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.

The technique was developed by Dr. Yosef Krespi, an otolaryngologist (ear, nose and throat surgeon) in New York City, chief of the Department of Otolaryngology at St. Luke's-Roosevelt Hospital.

Tonsillectomy is prescribed most often for young children with enlarged tonsils that obstruct breathing. This patient, Anne Zekoll, is 17.

Zekoll said the only things she really disliked about the procedure 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. Dr. Joseph 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.

Although she avoided the hospital stay and major pain, Zekoll looked forward to one thing traditionally associated with tonsil surgery: ice cream.

"I've decided on mint chocolate chip," she said.

The new surgery also helps adults whose tonsils have pockets, or crypts, that trap food and bacteria. Such 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, compared with nearly $10,000 for hospital surgery, said Krespi.

The procedure is called LAST, or Laser-Assisted Serial Tonsillectomy. It is performed using a hand-held device that directs a high-powered laser beam through two rapidly rotating mirrors.

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. "Afterwards, it's like a mild sore throat for a few days."

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.

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.

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.

The hand-held laser probe also is used for an operation called a LAUP (pronounced lay-up), or Laser-Assisted Uvuloplasty. The surgeon trims the uvula, the punching-bag-shaped bit of flesh dangling at the back of the mouth, to stop snoring and sleep apnea, a serious breathing obstruction.