The Evolution of Transoral Laser Microsurgery (TLM): A 600-Case Odyssey from CO₂ to Blue Laser Innovation
09-11, 12:15–12:45 (Europe/Istanbul), Head & Neck Oncology 4

<p>Speaker</p> <p>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)</p> <p>Overview</p> <p>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.</p> <p>Scientific and Clinical Focus</p> <p>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.</p> <p>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.</p> <p>Advanced Airway and Surgical Techniques</p> <p>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.</p> <p>Outcomes, Complications and Evidence</p> <p>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.</p> <p>Conclusion and Future Direction</p> <p>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.</p>
<p>The purpose of this proposal is to leverage my 13 years of senior clinical leadership and academic authority to deliver a high-impact keynote at IFOS 2026. As Founder/Director of the MCh Head & Neck Surgery and Director of DIHNE, I aim to share an evidence-based odyssey of 600 Transoral Laser Microsurgery (TLM) cases.</p> <p>By contrasting CO2 and Blue Laser technologies, I will provide a definitive blueprint for managing early and advanced laryngeal cancers. My objective is to translate complex technical "tricks"—refined through organizing 8 international conferences and 9 annual cadaveric courses—into actionable global surgical standards.</p>
Session Chair Session Chair
Oğuz Kuşcu
Speaker Speaker
jaiganesh manickavasagam
Oğuz Kuşcu
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jaiganesh manickavasagam
<p>Jaiganesh Manickavasagam (Jai Manick) is a distinguished Consultant Head and Neck Surgeon and clinical leader with over 13 years of senior experience. He currently holds several pivotal leadership roles, including Clinical Director for Cancer Services at NHS Tayside and Lead for Head and Neck Surgery at Ninewells Hospital. His career is characterized by a unique fusion of high-volume clinical expertise, academic innovation, and national governance.</p> <p>At the University of Dundee, he is the Founder and Director of the MCh Head and Neck Surgery program. This prestigious degree attracts surgeons globally, establishing a world-class curriculum for advanced surgical training. Complementing this, he serves as the Director of the Dundee Institute of Head and Neck Education (DIHNE). In this capacity, he leads the educational strategy for one of the UK’s premier training hubs, personally conducting nine annual hands-on cadaveric courses that provide essential technical training to the global ENT community.</p> <p>A pioneer in surgical technology, Jai Manick has surpassed the 100-case milestone in Transoral Robotic Surgery (TORS). His series is notably distinct from standard datasets; while it covers tongue base and tonsil tumors, it places a heavy emphasis on complex oncological resections and rare "post-malignancy" pharyngeal cases. This extensive experience allows him to provide an evidence-based perspective on the entire patient journey—from multidisciplinary team (MDT) planning and robotic simulation to the management of complex complications and long-term functional outcomes.</p> <p>His influence extends to the highest levels of professional governance. He is the Secretary of the ENTUK Head and Neck Council and the Assistant Secretary for ENT Scotland. These roles involve shaping national clinical standards and representing the specialty in major strategic forums. His organizational prowess is further evidenced by his role as the lead organizer for eight international conferences, which have successfully hosted over 8,000 national and international delegates, fostering a global exchange of surgical knowledge.</p> <p>An active researcher, he holds a Diploma in Clinical Trials from the University of Edinburgh and has served as the Principal Investigator (PI) for 14 national research projects. His work includes ground-breaking studies such as the first UK gene therapy trial for salivary glands. His academic reach is truly international, maintaining robust collaborations and visiting professorships across India, Egypt, and Germany.</p> <p>By combining his roles as a high-volume robotic surgeon, a visionary educator at DIHNE, and a key figure in ENTUK governance, Jai Manick remains at the forefront of the specialty. He is dedicated to "Serving Tomorrow’s World Today" by integrating advanced robotics, translational research, and multidisciplinary excellence into the global surgical landscape.</p>
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