Chest
Volume 94, Issue 1, July 1988, Pages 15-21
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Clinical Investigations
Nd:YAG Laser Bronchoscopy: A Five-Year Experience with 1,396 Applications in 1,000 Patients

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We treated 1,000 patients with the Nd:YAG laser. The rigid bronchoscope was used in 1,280 (92 percent) of the treatments, with patients almost always under general anesthesia; 116 (8 percent) treatments were performed with the flexible fiberoptic bronchoscope alone, with the use of local anesthesia. In almost all cases of benign tumors and in many carcinoid tumors, the treatment was curative. In genuine nonmalignant tracheal stenoses, laser therapy was curative in 34 out of 81 cases. In malignant tumors, the laser improved airway gauge 92 percent of the time. Cumulative survival was 50 percent (±3 percent) at six months and 26 percent (±3 percent) at one year. Following palliative laser therapy, eight patients with bronchogenic carcinoma appearing to be inoperable did have surgery and ten underwent less extensive surgery than expected. Results confirm the usefulness and safety of this relatively new method in the treatment of obstructive lesions of the tracheobronchial tree.

Section snippets

Materials and Methods

Almost all the patients treated had significant symptoms of airway obstruction due to a malignant or benign process. In some patients with lesions such as benign endoluminal tumors, selected carcinoids, early cancers, tracheobronchial granulomas, etc, laser therapy was performed for cure. In most instances, however, the laser was used as a palliative therapy for patients with endoluminal tracheobronchial lesions in whom conventional therapy had failed or had not been considered possible or

Results

From April 1982 to July 1987, 1,000 patients were treated with the YAG laser for a total of 1,396 procedures performed by the first author only. The number of treatments per year increased constantly: 64 in 1982, 205 in 1983, 256 in 1984, 308 in 1985, and 342 in 1986.

There were 772 tracheobronchial tumors, 139 nonmalignant tracheal stenoses and 89 miscellaneous conditions (Table 1).

Technique

Two different methods of laser application in bronchology have been developed: via the rigid or the fiberoptic bronchoscope. In general, the flexible method is opted for by bronchoscopists who have little or no experience with the rigid bronchoscope.

The preference for the rigid bronchoscope by authors with the largest series of cases8 and by ourselves is essentially for safety reasons: using the wide operating channel, the patient can be ventilated, blood and secretions aspirated, and laser

Addendum

A total of 1,751 treatments in 1,261 patients has now been performed. This additional experience has not modified our judgment on procedure.

ACKNOWLEDGMENT

We are grateful to Doctors F. Beamis and Stanley M. Shapshay for their helpful suggestions, thoughtful assistance and revision of the English text.

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Manuscript received November 16; revision accepted January 4.

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