Preliminary experience with the 1.32 μm neodymium-YAG laser in the treatment of tracheobronchial malignancy

Abstract

Endoscopic laser treatment for tracheobronchial malignancy is usually given with the neodymium-YAG laser using the 1.064μm output beam. However, recent experimental work suggests that the 1.32μm output beam of this laser has more desirable tissue effects. We have now treated 55 patients with the 1.32μm Nd-YAG laser (MBB-Medizintechnic) under general anaesthesia, using power settings of 10–20 W and pulse durations of up to 1 s. The indications for treatment were localized airway obstruction in each case. Airway calibre was improved in 46 (84%) patients and this was associated with an improvement in symptoms of cough and breathlessness. Patients with tracheal and carinal obstruction exhibited the most striking clinical improvements with up to four-fold increases in peak expiratory flow. In patients with more peripheral endobronchial obstruction, treatment improved airway calibre less frequently and resulted in a smaller clinical improvement. Of 11 patients with obstruction of a main bronchus and lung collapse, treatment led to partial or complete re-expansion in 10 cases (91%). The 1.32μm wavelength allows treatment to be conducted efficiently and safely but at a considerably lower power than is required for the 1.064μmwavelength. The ability to use low powers has the apparent advantage of generating only negligible quantities of smoke. Our experience with this new laser system demonstrates its considerable potential in the management of tracheobronchial malignancy.