Transoral laser microsurgery is used to treat some early throat cancers. A surgeon uses a laser and performs surgery through your mouth rather than through an incision. It may lead to voice changes and temporary difficulty swallowing.

If you’ve received a diagnosis of throat cancer, your care team may recommend surgery as part of your treatment plan. Transoral laser microsurgery (TLM) is a type of surgery that’s used to treat certain types of throat cancer.

During TLM, a surgeon removes the cancer through your mouth instead of through an incision in your neck. They use a specialized laser to carefully cut away the cancer while leaving nearby healthy tissue intact.

Read on to learn more about what TLM is used for, what the procedure involves, what recovery is like, and how effective it is.

TLM can be used to treat certain types of throat cancer, including cancers affecting your larynx (voice box) and hypopharynx (lower throat).

Both of these cancers are uncommon. The American Cancer Society estimates that 12,650 new cases of laryngeal cancer and up to 4,000 new cases of hypopharyngeal cancer will be diagnosed in the United States in 2024.

TLM is typically performed on early stage tumors, which are generally still small and have not spread deeper into surrounding tissue.

Before your TLM, you’ll meet with the surgeon. They will go over the procedure, its potential risks, and what you can expect during recovery.

You’ll undergo some tests to help the surgeon get a good idea of your overall health and determine whether you’re a good candidate for the surgery. These may include blood tests, imaging tests, and an endoscopy.

You will also meet with a speech-language therapist before the procedure. They’ll evaluate your speech and swallowing and discuss how TLM may affect these functions and what recovery will be like.

You’ll receive instructions on how to prepare for your surgery, including information such as:

  • which medications to adjust before your surgery and when to do so
  • when to start fasting the night before your surgery
  • what to bring with you to the hospital on the day of your surgery

Be sure to carefully follow any preparation instructions that you receive. Doing so will help ensure that your TLM can proceed as scheduled.

TLM is performed while you’re under general anesthesia. This means you’ll be unconscious and won’t feel anything during your surgery.

A surgeon will pass an endoscope through your mouth and into your throat to help them find the tumor. An endoscope is a flexible tube that has a light on the end. Surgical tools can also be passed through the endoscope.

When your surgeon finds the tumor, they’ll use a specialized laser to remove it. The laser tool has a microscope attached to it, which allows your surgeon to carefully cut away the tumor.

The surgeon will also remove a small area of healthy tissue around the tumor. This is called the margin. A pathologist typically tests the margin for cancer cells to find out whether all the cancer has been removed.

Once the surgeon has finished removing the tumor, they’ll withdraw the endoscope and surgical tools. You’ll then be taken to the recovery room.

You’ll likely have pain in your throat right after your surgery. This typically lasts for about 2 days, and your doctor may recommend taking pain relievers if necessary.

A speech-language therapist will evaluate your swallowing and speech. They can give you exercises to do to help with swallowing.

If you’re having trouble swallowing, healthcare professionals may temporarily place a nasogastric tube, which runs from your nose down into your stomach, to ensure that you’re getting enough nutrition.

Healthcare professionals may also advise you to avoid speaking for several days after your surgery. When you can speak again, a speech-language therapist can work with you to help your voice recover if it has been affected.

The length of your hospital stay can depend on the extent of the TLM, how the procedure went, and how you’re doing afterward. Some people may be able to go home the same day or the next day, while others may need to stay for a few days.

Recovering from TLM may take several weeks. Your surgeon will schedule a follow-up visit during your recovery period.

At the follow-up visit, they’ll check on how you’re healing, tell you about the results of any tests on tissue samples, and discuss the next steps.

One of the main benefits of TLM is that it’s less invasive than open surgical approaches. This means that you’ll likely recover more quickly and that the tissues of your larynx or hypopharynx are more likely to be preserved.

But how does TLM compare with other cancer treatments? While this varies based on the size and location of the tumor, TLM generally has similar or better results than other treatments, depending on what’s being measured.

Let’s look at what some of the research says.

Research into transoral laser microsurgery effectiveness

The authors of a 2019 research review analyzed the outcomes of 16 studies of TLM or radiation therapy for small tumors in the larynx. They found that there was no difference between the two treatments in local control of the cancer.

However, compared with radiation therapy, TLM was associated with better:

  • overall survival
  • disease-specific survival
  • larynx preservation

A 2023 study found that TLM and open surgery were associated with similar rates of overall survival and disease-specific survival.

A 2020 review found that open surgery provided better local control of cancer than TLM and radiation therapy. Both TLM and open surgery were associated with better larynx preservation than radiation therapy.

In a 2019 study, researchers looked at voice outcomes and quality of life after TLM for early stage cancer. Participants reported good quality of life 2 years after TLM. They also reported mild to moderate hoarseness and low levels of voice issues.

It’s important to talk with your surgeon about the risks and benefits of these procedures so that you have a better understanding of the surgical plan and the expected outcome.

TLM does come with a risk of some complications, including:

Your surgeon will discuss these risks with you before your surgery.

TLM is a type of surgery used to treat early stage laryngeal and hypopharyngeal cancers. It’s less invasive than open approaches and is associated with shorter recovery time and better preservation of throat tissue.

Recovery from TLM can often take several weeks. During this time, you may have temporary difficulties with swallowing and notice changes to your voice.

If your healthcare team recommends TLM as part of your treatment plan, it’s important to have an open conversation about the procedure. They can best inform you about its benefits and risks and what to expect regarding the outcome and recovery.