Use of Medical Lasers for Airway Disease

  • Jeffrey B. HoagEmail author


Since the first description nearly half a century ago, medical lasers have become a vital component of the therapeutic armamentarium of interventional pulmonologists. Over this time, medical lasers have been utilized to relieve nearly every form of airway luminal obstruction with beneficial effect on patient symptoms. Through the review of more than 10,000 published airway laser applications, our collective understanding of the power of this technique has been refined. With the growing access to this powerful tool exists an obligation of the operator to fully realize the mechanism of how lasers work, appropriate indications, complications, techniques, safeguards, and outcomes of employing medical lasers for therapeutic effects in the airway. The following chapter provides a discussion of these points designed to serve as a reference for the interventionalist interested in the use of medical lasers.


Laser Therapy Medical Laser Contact Probe Nitinol Stents Rigid System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Strong MS, Jako GJ, Polanyi T, Wallace RA. Laser surgery in the aerodigestive tract. Am J Surg. 1973;126:529–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Laforet EG, Berger RL, Vaughan CW. Carcinoma obstructing the trachea. Treatment by laser resection. N Engl J Med. 1976;294:941.PubMedCrossRefGoogle Scholar
  3. 3.
    Jako GJ, Vaughan CW, Strong MS, Polanyi TG. Surgical management of malignant tumors of the aerodigestive tract with carbon dioxide laser microsurgery. Int Adv Surg Oncol. 1978;1:265–84.PubMedGoogle Scholar
  4. 4.
    Toty L, Personne C, Colchen A, Vourc’h G. Bronchoscopic management of tracheal lesions using the neodymium yttrium aluminium garnet laser. Thorax. 1981;36:175–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Dumon JF, Reboud E, Garbe L, Aucomte F, Meric B. Treatment of tracheobronchial lesions by laser photoresection. Chest. 1982;81:278–84.PubMedCrossRefGoogle Scholar
  6. 6.
    McDougall JC, Cortese DA. Neodymium-YAG laser therapy of malignant airway obstruction. A preliminary report. Mayo Clin Proc. 1983;58:35–9.PubMedGoogle Scholar
  7. 7.
    Mehta AC, Golish JA, Ahmad M, Zurick A, Padua NS, O’Donnell J. Palliative treatment of malignant airway obstruction by Nd-YAG laser. Cleve Clin Q. 1985;52:513–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Shapshay SM. Laser applications in the trachea and bronchi: a comparative study of the soft tissue effects using contact and noncontact delivery systems. Laryngoscope. 1987;97(Suppl):1–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Cavaliere S, Foccoli P, Farina PL. Nd:YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients. Chest. 1988;94:15–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Brenner M, Shankel T, Wang NS, Waite TA, Wong H, Hamilton A, Tadir Y, Milner T, Boyajian J, Chung E, Tromberg B, Wilson AF, Berns MW. CO2 and Nd:YAG laser-induced pulmonary parenchymal lung injury in a rabbit model. Am J Respir Crit Care Med. 1996;153:1136–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Parrish JA, Walsh Jr JT. Potentials for progress in laser medicine. Yale J Biol Med. 1985;58:535–45.PubMedGoogle Scholar
  12. 12.
    Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation, and stents. Eur Respir J. 2006;27:1258–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Dumon JF, Shapshay S, Bourcereau J, Cavaliere S, Meric B, Garbi N, Beamis J. Principles for safety in application of neodymium-YAG laser in bronchology. Chest. 1984;86:163–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Feller-Kopman D, Lukanich JM, Shapira G, Kolodny U, Schori B, Edenfield H, Temelkuran B, Ernst A, Schindel Y, Fink Y, Fox J, Bueno R. Gas flow during bronchoscopic ablation therapy causes gas emboli to the heart: a comparative animal study. Chest. 2008;133:892–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Moghissi K, Pender D. Instrumental perforations of the oesophagus and their management. Thorax. 1988;43:642–6.PubMedCrossRefGoogle Scholar
  16. 16.
    George PJ, Garrett CP, Nixon C, Hetzel MR, Nanson EM, Millard FJ. Laser treatment for tracheobronchial tumours: local or general anaesthesia? Thorax. 1987;42:656–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Brutinel WM, Cortese DA, McDougall JC, Gillio RG, Bergstralh EJ. A two-year experience with the neodymium-YAG laser in endobronchial obstruction. Chest. 1987;91:159–65.PubMedCrossRefGoogle Scholar
  18. 18.
    Beamis Jr JF, Shapshay SM. More about the YAG. Chest. 1985;87:277–8.PubMedCrossRefGoogle Scholar
  19. 19.
    McCaughan Jr JS, Heinzmann HG, McMahon D. Impacted broncholiths removed with the holmium: YAG laser. Lasers Surg Med. 1996;19:230–2.PubMedCrossRefGoogle Scholar
  20. 20.
    Casey KR. Preventing endotracheal fires. Chest. 1987;91:637.PubMedCrossRefGoogle Scholar
  21. 21.
    Kvale PA, Eichenhorn MS, Radke JR, Miks V. YAG laser photoresection of lesions obstructing the central airways. Chest. 1985;87:283–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Moghissi K, Dixon K. Bronchoscopic NdYAG laser treatment in lung cancer, 30 years on: an institutional review. Lasers Med Sci. 2006;21:186–91.PubMedCrossRefGoogle Scholar
  23. 23.
    Madden BP, Kumar P, Sayer R, Murday A. Successful resection of obstructing airway granulation tissue following lung transplantation using endobronchial laser (Nd:YAG) therapy. Eur J Cardiothorac Surg. 1997;12:480–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Madden BP, Datta S, McAnulty G. Tracheal granulation tissue after percutaneous tracheostomy treated with Nd:Yag laser: three cases. J Laryngol Otol. 2001;115:743–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Madden BP, Lee M, Paruchuru P. Successful treatment of endobronchial amyloidosis using Nd:YAG laser therapy as an alternative to lobectomy. Monaldi Arch Chest Dis. 2001;56:27–9.PubMedGoogle Scholar
  26. 26.
    Miks VM, Kvale PA, Riddle JM, Lewis Jr JW. Broncholith removal using the YAG laser. Chest. 1986;90:295–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Lennon RL, Hosking MP, Warner MA, Cortese DA, McDougall JC, Brutinel WM, Leonard PF. Monitoring and analysis of oxygenation and ventilation during rigid bronchoscopic neodymium-YAG laser resection of airway tumors. Mayo Clin Proc. 1987;62:584–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Vanderschueren RG, Westermann CJ. Complications of endobronchial neodymium-Yag (Nd:Yag) laser application. Lung. 1990;168(Suppl):1089–94.PubMedCrossRefGoogle Scholar
  29. 29.
    Scherer TA. Nd-YAG laser ignition of silicone endobronchial stents. Chest. 2000;117:1449–54.PubMedCrossRefGoogle Scholar
  30. 30.
    Witt C, Schmidt B, Liebetruth J, Baumann G. Nd:YAG laser and tracheobronchial metallic stents: an experimental in vitro study. Lasers Surg Med. 1997;20:51–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Hautmann H, Huber RM. Laser resistance of expandable metal stents in interventional bronchoscopy: an experimental evaluation. Lasers Surg Med. 2001;29:70–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Dalupang JJ, Shanks TG, Colt HG. Nd-YAG laser damage to metal and silicone endobronchial stents: delineation of margins of safety using an in vitro experimental model. Chest. 2001;120:934–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Young O, Kirrane F, Hughes JP, Fenton JE. KTP laser and nitinol alloy stents: are they compatible? Lasers Surg Med. 2007;39:803–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Tellides G, Ugurlu BS, Kim RW, Hammond GL. Pathogenesis of systemic air embolism during bronchoscopic Nd:YAG laser operations. Ann Thorac Surg. 1998;65:930–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Lang NP, Wait GM, Read RR. Cardio-cerebrovascular complications from Nd:YAG laser treatment of lung cancer. Am J Surg. 1991;162:629–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Mehta AC, Golish JA, Livingston DR. Loss of fiberoptic laser tip. Chest. 1985;88:798.PubMedCrossRefGoogle Scholar
  37. 37.
    Mehta AC, Grimm M. Breakage of Nd-YAG laser sapphire contact probe inside the endobronchial tree. Chest. 1988;93:1119.PubMedCrossRefGoogle Scholar
  38. 38.
    Livingston DR, Mehta AC, Golish JA, Ahmad M, Deboer G, Tomaszewski MZ. Palliation of malignant tracheobronchial obstruction by Nd-YAG laser: an update of experience at the Cleveland Clinic Foundation. J Am Osteopath Assoc. 1987;87:226–34.PubMedGoogle Scholar
  39. 39.
    Lee P, Kupeli E, Mehta AC. Therapeutic bronchoscopy in lung cancer. Laser therapy, electrocautery, brachytherapy, stents, and photodynamic therapy. Clin Chest Med. 2002;23:241–56.PubMedCrossRefGoogle Scholar
  40. 40.
    Shapshay SM, Beamis Jr JF. Safety precautions for bronchoscopic Nd-YAG laser surgery. Otolaryngol Head Neck Surg. 1986;94:175–80.PubMedGoogle Scholar
  41. 41.
    Hujala K, Sipilä J, Grenman R. Endotracheal and bronchial laser surgery in the treatment of malign and benign lower airway obstructions. Eur Arch Otorhinolaryngol. 2003;260:219–22.PubMedGoogle Scholar
  42. 42.
    Shapshay SM, Dumon JF, Beamis Jr JF. Endoscopic treatment of tracheobronchial malignancy. Experience with Nd-YAG and CO2 lasers in 506 operations. Otolaryngol Head Neck Surg. 1985;93:205–10.PubMedGoogle Scholar
  43. 43.
    Personne C, Colchen A, Leroy M, Vourc’h G, Toty L. Indications and technique for endoscopic laser resections in bronchology. A critical analysis based upon 2,284 resections. J Thorac Cardiovasc Surg. 1986;91(5):710–5.PubMedGoogle Scholar
  44. 44.
    Desai SJ, Mehta AC, VanderBrug Medendorp S, Golish JA, Ahmad M. Survival experience following Nd:YAG laser photoresection for primary bronchogenic carcinoma. Chest. 1988;94:939–44.PubMedCrossRefGoogle Scholar
  45. 45.
    Shea JM, Allen RP, Tharratt RS, Chan AL, Siefkin AD. Survival of paients undergoing Nd:YAG laser therapy compared with Nd:YAG laser therapy and brachytherapy for malignant airway disease. Chest. 1993;103:1028–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Eichenhorn MS, Kvale PA, Miks VM, Seydel HG, Horowitz B, Radke JR. Initial combination therapy with YAG laser photoresection and irradiation for inoperable non-small cell carcinoma of the lung. A preliminary report. Chest. 1986;89:782–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Moghissi K, Dixon K, Hudson E, Stringer M, Brown S. Endoscopic laser therapy in malignant tracheobronchial obstruction using sequential Nd YAG laser and photodynamic therapy. Thorax. 1997;52:281–3.PubMedCrossRefGoogle Scholar
  48. 48.
    Ross DJ, Mohsenifar Z, Koerner SK. Survival characteristics after Neodymium: YAG laser photoresection in advanced stage lung cancer. Chest. 1990;98:581–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Stanopoulos IT, Beamis JF, Martinez FJ, Vergos K, Shapshay SM. Laser bronchoscopy in respiratory failure from malignant aiway obstruction. Crit Care Med. 1993;21:386–91.PubMedCrossRefGoogle Scholar
  50. 50.
    Han CC, Prasetyo D, Wright GM. Endobronchial palliation using Nd:YAG laser is associated with improved survival when combined with multimodal adjuvant treatments. J Thorac Oncol. 2007;2:59–64.PubMedCrossRefGoogle Scholar
  51. 51.
    Fuks L, Fruchter O, Amital A, Fox BD, Rahman NA, Kramer MR. Long-term follow-up of flexible bronchoscopic treatment for bronchial carcinoids with curative intent. Diagn Ther Endosc. 2009;2009:782961.PubMedCrossRefGoogle Scholar
  52. 52.
    Shapshay S, editor. Endoscopic laser surgery handbook. New York: Marcel Dekker; 1991. p. 1–131.Google Scholar
  53. 53.
    Dumon JF, editor. YAG laser bronchoscopy, Surgical science series, vol. 5. New York: Praeger Special Studies; 1985. p. 1–116.Google Scholar
  54. 54.
    Prakash UBS, editor. Bronchoscopy. New York: Raven; 1994. p. 279–91.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Medicine and SurgeryCancer Treatment Centers of America, Eastern Regional Medical CenterPhiladelphiaUSA

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