Animal experiments were performed with evaluation of the use of the
neodymium-
YAG (yttrium-aluminum-garnet)
laser in the trachea, bronchi, and pulmonary parenchyma. Histologic evaluation of incisions into the lung was assessed by multiple sections over a 5-week period and comparisons were made of incisions closed with chronic
catgut or coagulated with electric
cautery or by the
laser. These studies indicated that the
laser is more effective in controlling parenchymal
bleeding and air leaks than either the
cautery or chromic
catgut and produces less local tissue reaction. The
Nd-YAG laser has been used clinically to treat patients with inoperable obstructing and
bleeding carcinomas of the trachea and main bronchi to open the involved airway and to restore pulmonary function. Fifteen patients have had 26 treatments using the
Nd-YAG laser. Total
laser time was limited to 15 minutes with 0.5-second pulses of 50 to 80 watts being delivered via the fiberoptic and straight
bronchoscope as indicated. It is extremely effective in controlling
hemoptysis from recurrent endobronchial lesions, and obstructing lesions in the trachea and main stem bronchus can be treated quite successfully with excellent palliation. It is apparent that continued clinical use of the
Nd-YAG laser as
palliative therapy for
bleeding and obstructing
tumors of the tracheobronchial tree is indicated and expanded use at the time of
thoracotomy to control lung parenchymal
bleeding and air leaks should be considered in the future.