Laser Applications in Lung Parenchyma Surgery
Abstract:Although the bronchoscopical endoluminal laser coagulation and vaporisation of central bronchial carcinoma has been globally used as a standard procedure since the early eighties, laser application still remains the exception in thoracic surgery, even in medical centres. There are two main reasons for this unsatisfactory situation: a lack of basic research, and a false perception of the capabilities offered by the 1064 nm Nd:YAG laser. To date, our working group is the only one that has demonstrated the advantages of the Nd:YAG laser's 1318 nm wavelength for lung parenchyma resections.
Owing to its 80% water content, the lowest tissue density of all parenchymatous organs and its strong tendency to shrink as a result of its air content, the lung is the ideal organ for photothermal laser applications. Since the 1318nm wavelength shows a ten times higher absorption in water than its 1064 nm counterpart, the desired combination effect – cutting capability plus coagulation plus fistula sealing – can be achieved only with this laser. This combination effect enables virtually any form of parenchyma resection, and centrally located tumours can be haemostatically exposed and resected. The technical advances can best be seen in lung metastatic surgery. The results obtained after laser resection of multiple metastases in 100 patients clearly show a parenchyma-sparing effect as evidenced by the reduction in the lobectomy rate from 25% to 5%. Despite a significant increase in the number of metastases (to an average 6.3 and a maximum of 124 metastases per patient), and including bilateral and synchronous metastases, the 5-year survival rates remained constant at 32.5% as described in the literature. The most important prognosis factor is complete resection, which could be performed as a precision resection in 95% of all cases despite the fact that 41% of these metastases were centrally located.
The future will show whether the introduction of the 1318 nm Nd:YAG laser into lung parenchyma surgery will produce a similar progress as could be achieved in liver parenchyma surgery some ten years ago through the introduction of the CUSA and water jet techniques.
Document Type: Research Article
Affiliations: Department of Thoracic and Vascular Surgery, Coswig Specialised Hospital, Centre for Pneumology and Thoracic Surgery, Coswig/Dresden, Germany
Publication date: December 1, 2003