Abstract
Patients suffering from severe tracheobronchial obstruction are vulnerable to dyspnea, respiratory failure, obstructive pneumonia, and death. Treatment with a holmium:YAG laser, an alternative to the neodymium:YAG laser, may provide symptomatic relief. This is the largest case series to date describing the application of the holmium:YAG laser via bronchoscopy for benign and malignant obstructive disease. The data were retrospectively collected from 99 patients, with either benign or malignant tracheobronchial obstruction, who underwent 261 interventional bronchoscopy procedures in the operating room with laser ablation between January 2004 and November 2011. Categorical variables were analyzed with the chi-square and Fisher’s exact tests as appropriate in contingency tables, whereas Student’s t-test was performed for comparison of continuous variables. Patient follow-up was concluded on September 15, 2013. The holmium:YAG laser was used in 261 procedures performed on 99 patients with either benign or malignant disease. Symptomatic improvement was demonstrated in 90 % of all benign etiology cases and 77 % of all malignant etiology cases. Within the benign and malignant subgroups, improvement was dependent on anatomical location rather than etiology of the lesion. Complications occurred in 2.3 % of the procedures, with mortality in less than 1 % of procedures. Results confirm the usefulness and safety of the holmium:YAG laser in the treatment of patients with severe benign and malignant obstructive tracheobronchial obstructions. The holmium:YAG laser is an appealing alternative to the neodymium:YAG laser.
Similar content being viewed by others
References
Bolliger CT, Suteja TG, Strausz J, Freitag L (2006) Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J 27:1258–1271
Wood DE, Liu YH, Vallieres E, Karmy-Jones R, Mulligan MS (2003) Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 76:167–174
Cavaliere S and Dumon JF. Laser bronchoscopy. In: Bolliger CT and Mathur PN (eds) Interventional bronchoscopy. Prog Respir Res. Basel, Karger 2000;30:108-119.
Fisher JC (1983) The power density of a surgical laser beam: its meaning and measurement. Lasers Surg Med 2(4):301–315
Sagie D, Kalisky Y, Kagan J, Loten H. Holmium laser. Patent number 5,107,513. 21 Apr 1992.
Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD (2002) Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31–34
Unger M (1985) Neodymium:YAG laser therapy for malignant and benign endobronchial obstructions. Clin Chest Med 6:277–290
Dumon JF, Shapsay SM, Borcerau J, Cavaliere S, Meric B, Garbe N, Beamis J (1984) Principles for safety in the application of neodymium-YAG laser in bronchology. Chest 86:163–168
Cavaliere S, Venuta F, Foxxoli P, Tonineli C, La Face B (1996) Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 110:1536–1542
Desai SJ, Metha AC, Vanderbrug A et al (1988) Survival experience following Nd:YAG laser photoresection for primary bronchogenic carcinoma. Chest 94:939–944
Brutinel WM, Cortese DA, McDougall JC et al (1987) A 2-year experience with the neodymium YAG laser in endobronchial obstruction. Chest 91:159–165
Ross DJ, Mohsenifar Z, Koerner SK (1990) Survival characteristics after neodymium:YAG laser photoresection in advanced stage lung cancer. Chest 96:581–585
Alberg AJ, Samet JM (2003) Epidemiology of lung cancer. Chest 123:21S–49S
Sprio SG, Gould MK, Colice GL (2007) Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132:149S–160S
Miller JI, Phillips TW (1990) Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thor Surg 50:190–196
Cavaliere S, Foccoli P, Farina PL (1988) Nd:YAG laser bronchoscopy: a five-year experience with 1,396 applications in 1,000 patients. Chest 94:15–21
Acknowledgments
Thank you to Leah Gaither and Colby Ayers for their help in the preparation of this manuscript. Thank you also to Lew Calver for his illustration of Fig. 2.
Disclosure
No conflicts of interest are reported by any authors of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Squiers, J.J., Teeter, W.A., Hoopman, J.E. et al. Holmium:YAG laser bronchoscopy ablation of benign and malignant airway obstructions: an 8-year experience. Lasers Med Sci 29, 1437–1443 (2014). https://doi.org/10.1007/s10103-014-1536-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-014-1536-1