Speaker

Jaiganesh Manickavasagam (Jai Manick), MS(ENT), FRCS(ORL-HNS) Consultant Head & Neck Surgeon and Clinical Director for Cancer Services, NHS Tayside Founder & Director, Dundee Institute of Head & Neck Education (DIHNE)

Overview

Transoral Laser Microsurgery (TLM) has fundamentally transformed the management of laryngeal malignancy by providing organ-preserving, function-sparing alternatives to open surgery and radiotherapy. Over the past 13 years, I have developed one of the largest single-surgeon TLM experiences in the UK, comprising more than 600 cases across the full spectrum of laryngeal disease, from Tis and early glottic carcinoma to carefully selected T3 tumours. This keynote will present a comprehensive, outcomes-driven analysis of this experience, framed within the evolution of laser technology and its impact on precision oncologic surgery.

Scientific and Clinical Focus

A central theme of this lecture is the technological evolution of laser systems in laryngeal surgery, particularly the complementary roles of CO₂ and 445-nm blue laser platforms. While CO₂ remains the gold standard for precise cutting and margin control due to its high absorption in water, the introduction of the blue laser has added a new dimension to photoangiolytic and haemoglobin-selective tissue interaction. Through comparative case series and video-based illustration, this keynote will demonstrate how these two technologies can be used synergistically rather than competitively.

The CO₂ laser allows cold-like, oncologically precise excision of bulky tumours, facilitating en-bloc or controlled piecemeal resections with excellent histological margins. In contrast, the blue laser offers exceptional haemostasis and vocal fold preservation, particularly in highly vascular tumours, papillomatosis, dysplasia, and early glottic cancer, enabling bloodless surgery with superior functional outcomes. The lecture will show how appropriate wavelength selection improves margin control, reduces thermal injury, and enhances post-operative voice and swallowing.

Advanced Airway and Surgical Techniques

Laser laryngeal surgery demands meticulous airway control and interdisciplinary coordination. Drawing on experience as Director of DIHNE and Principal Investigator on multiple national trials, this keynote will share practical strategies for safe and efficient airway management, including jet ventilation, laser-safe tubes, and exposure techniques for challenging anterior commissure and supraglottic tumours. Evidence-based discussion will address the en-bloc versus piece-meal resection debate and how technique selection influences oncologic and functional outcomes.

Outcomes, Complications and Evidence

Longitudinal outcome data from this 600-case cohort will be presented, including local control, laryngeal preservation, voice and swallowing outcomes, and retreatment rates. An honest and practical discussion of complications—airway fires, secondary haemorrhage, chondritis, and stenosis—will be included, focusing on prevention, early recognition, and MDT-led management.

Conclusion and Future Direction

Using high-definition surgical videos, this keynote will bridge clinical science with surgical craftsmanship, illustrating how modern laser technology enables safe escalation from early-stage disease to complex organ-preserving surgery in advanced laryngeal cancer. This presentation will provide IFOS delegates with a contemporary, evidence-based roadmap for mastering TLM in the era of precision laryngeal oncology.

Precision and Perplexity: A 13-Year Journey in Managing Advanced Parotid Cancer – Evidence, Ethics, and Expertise

Format: Keynote Lecture (30 Minutes)

Speaker: Jaiganesh Manickavasagam (Jai Manick), MS(ENT), FRCS(ORL-HNS)

Theme: Serving Tomorrow’s World Today: Therapeutic Innovations

Proposal OutlineIntroduction and Global Context The management of advanced parotid cancer remains one of the most challenging frontiers in Head and Neck surgery. As we look toward 2030, the paradigm is shifting from "radicality at all costs" to "precision oncology." Drawing upon my 13 years of experience as a Consultant Head and Neck Surgeon and Clinical Director for Cancer Services at NHS Tayside, this keynote addresses the management of T3/T4 parotid malignancies.

The Evidence-Based Evolution The session will provide a longitudinal analysis of parotid cancer management, transitioning from traditional surgical approaches to evidence-led, multidisciplinary-driven outcomes. I will discuss the clinical integration of 14 national research projects—where I served as Principal Investigator—and how data from trials like the AQUAx2 (Gene Therapy) and others are beginning to reshape our understanding of salivary gland biology and treatment response.

Surgical "Tricks and Tools" A core segment of this lecture will focus on the "Dundee Experience," utilizing my dual role as Director of the Dundee Institute of Head and Neck Education (DIHNE) and Founder of MCh Head and Neck Surgery. I will share specific surgical pearls gathered over a decade of high-volume practice, including:

- The Facial Nerve Dilemma: Decision-making frameworks for nerve sacrifice vs. preservation in high-grade tumors.
- Advanced Reconstructive Stratagems: Utilizing local and free-flap options to provide both structural integrity and aesthetic restoration.
- Robotic and Digital Adjuncts: The role of precision technology in navigating the deep lobe and skull base interface.

Case Series and The Patient Journey The presentation is anchored by high-definition video case studies of advanced malignancies involving the facial nerve, mastoid, and parapharyngeal space. I will present a unique series of "post-malignancy" reconstructions, mapping the full patient journey from multidisciplinary team (MDT) counseling to functional recovery. These cases illustrate the fine balance between oncological clearance and quality of life.

Conclusion: Tomorrow’s Blueprint I will conclude by addressing the "Complexity Gap"—the space between clinical guidelines and real-world surgical challenges. By synthesizing 13 years of leadership and academic rigor, this keynote provides a blueprint for managing parotid cancer through the lens of surgical innovation, translational science, and compassionate patient care.