In the mid-19th century, the first transoral laryngeal procedures were performed in awake patients without sedation. As topical and general anesthesia techniques advanced toward the turn of the 20th century, laryngeal surgeons transitioned such care to the operating room, where improved visualization and precision were achieved under anesthesia. During this period of endoscopic laryngeal surgery, the armamentarium of surgeons expanded greatly, and several procedural innovations were made, although for some recurrent conditions, the operating room setting presented drawbacks. For benign diseases, surgeons developed individualized functional thresholds, typically measured by ventilatory or phonatory dysfunction, for taking a patient to the operating room for surgical treatment. This protocol is, of course, more problematic in recurrent diseases, such as papillomatosis, which inherently require repeated and often frequent surgical procedures that impart safety, logistical, and cost burdens.
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