This is a prospective randomized interventional comparative research which is conducted on 53 cases with vocal folds cysts. These cases were randomly divided into two groups: group 1 (27 cases) was operated by the conventional technique, and group 2 (26 cases) was operated with CO2 laser microlaryngeal surgery. The study was conducted after approval from the ethics committee. Written informed consent was taken from all cases.
The inclusion criteria are cases with vocal fold cysts not responding to conservative management with normal freely mobile bilateral vocal folds, while cases with the previous microlaryngeal surgery for any cause, immobile vocal folds, malignant vocal fold lesions, and not fit for general anesthesia were excluded.
It was conducted by expert otolaryngologists and senior phoniatrician which included the following:
Complete history taking
Vocal fold cyst was diagnosed in every patient using flexible or rigid laryngoscope with evaluation of the mobility of vocal folds.
GRBAS scale (grade of hoarseness, roughness, breathiness, asthenia, and strain)
Arabic version of Voice Handicap Index (VHI) 
All cases were controlled by general anesthesia using the smallest endotracheal tube considered safe to every patient. Laser-safe endotracheal tubes were chosen for cases who were operated on by laser. All cases were given an intraoperative dosage of 8 mg dexamethasone.
All surgeries were performed by the senior author using an operating microscope at 400-mm focal length by a suspension laryngoscope to expose the vocal folds.
In the first group of patients, conventional surgeries were performed using cold microsurgical instruments. The surgeon grasped the medial edge of the cyst with microforceps, and then, he sharply excised the lateral edge with a laryngoscopic knife or scissor. Dissection and excision of the cysts were performed in the highly superficial plane to prevent trauma to the deeper layers.
In the second group of patients, a microspot CO2 surgical laser was used with 1035 nm wavelength, 2 W power, and beneath continuous super-pulse mode. All laser precautions and protection for the patients and the operation room staff were done. The vocal fold cyst was exposed as in first group of the study, and gauzes soaked in saline were positioned at the subglottic area to keep the endotracheal tubes and avoid laser harm to surrounding tissues. The laser beam was focused to the smallest spot size (0.2–0.25 mm). The lesion was clasped with microforceps and removed by the laser in a superficial plane to prevent damage to the deep layer of the lamina propria.
All samples were referred to the pathology department for histological sectioning and diagnosis.
Cases were put on a regimen of 2 weeks of voice rest and hydration. Antireflux measures were prescribed to all cases for at least 4 weeks postoperatively. Smokers were invited to carry out smoking cessation.
Postoperative assessment was done 3 months postoperatively by GRBAS scale, stroboscopic analysis, and VHI and detect recurrence.
Data were examined by SPSS version 15. Normally distributed scale variables were explained as mean and standard deviation. Qualitative variables were presented as frequency and percentage. Comparison among groups regarding a qualitative variable was performed by chi-square test; however, the comparison between two groups regarding a normally distributed scale variables was performed by independent t-test. Additionally, the comparison of a normally distributed paired variable was performed by paired t-test to compare between pre- and post-surgery parameters, while McNemar test was utilized to compare paired qualitative data.