Neodymium-YAG Laser Treatment of Intrabronchial Lesions: A New Mapping Technique via the Flexible Fiberoptic Bronchoscope

Abstract

We report the results of the treatment of 45 patients (38 with malignant and seven with benign disease) with intrabronchial lesions using the neodymium-YAG laser via the flexible fiberoptic bronchoscope. Multiple treatment sessions were used with treatment intervals varying from four days to four weeks. Additional debridement procedures were also necessary in select cases. (There was total of 109 treatments in 45 patients). Over 70 percent (81 of 109) of all treatments were done without intubation and with sedation techniques, and topical lidocaine application similar to that used in standard fiberoptic bronchoscopy. Laser treatment of the less extensive segmental lesion resulted in very meaningful palliation and laser therapy need not be reserved for extensive central disease only. In our judgment, this can most safely be done with a "real time, intrabronchial mapping technique." The Mill Rose (W-22-13) transbronchial needle was used intraoperatively to perforate blind intrabronchial obstructions. Renografin (Ren-M-60 M) was then hand injected to locate and fluoroscopically visualize the postobstructive bronchial remnant. Precise laser penetration into the postobstructive remnant was then possible by following the same pathway. This technique greatly extended our ability to safely perforate segmental and even blind central obstructing lesions. In our judgment, without a "real time intrabronchial mapping technique," vascular and bronchial perforations would be more likely when treating the more distal lobar and segmental obstructions.