Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Abstract

Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998–2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.

Interventional therapy via flexible bronchoscopy in the management of foreign body‐related occlusive endobronchial granulation tissue formation in children

“…Furthermore, holmium laser possesses several properties over CO 2 laser 21,22 : (i) it can be transmitted by fiber‐optic delivery system to get reliable access to lobar and segment bronchi and target the lesion of tracheobronchial tree more precisely; (ii) it has a unique feature of minimal penetration depth to approximately 0.4 mm, which minimizes collateral damage to the surrounding tissues; (iii) its maximal effective distance is only 5 mm, limiting unwanted firing of the laser into normal tissue; and (iv) it cuts thick scar tissue and bone without overheating, and shows good hemostasis. Verret et al 23 demonstrated no intraoperative or postoperative complications were found in the utility of holmium laser treatment for benign tracheal stenosis. Likely, we successfully ablated granuloma without any complication related to holmium laser use.…”

Novel technique of flexible endoscopic therapy of Zenker’s diverticulum using a pulsed Holmium laser—a retrospective single-center analysis

“…This is, to our knowledge, the first report about a patient cohort treated with FED-LD with a PHL. In the upper aerodigestive tract PHL has been used for treatment of benign tracheal stenosis with extremely low rate of adverse events [ 13 ]. In our study, the safety of FED-LD has been demonstrated with a low rate of intraoperative adverse events of 4% (2 cases) which were both managed endoscopically during the same intervention without any need for further interventional treatment.…”

“…An advantage of the PHL in comparison to the CO 2 laser is the short wavelength and thereby short penetration of the tissue resulting in a clean and sharp cut [ 13 ]. Therefore, a complete dissection of the common wall of the diverticulum without increasing the risk of transmural defects is possible.…”

“…Furthermore, the PHL has the capability of working in environments such as air, saline and wet tissue in opposite to the CO 2 laser, which is almost exclusively absorbed by water [ 13 ]. Of note, incidents of airway fire caused by CO 2 laser have been reported [ 14 , 15 ], the PHL seems to have no such risk features.…”

Multimodality Surgical Approach in Management of Laryngotracheal Stenosis

“…The ease of use with a fiber also enables this laser to be used endoscopically with flexible scopes. Hence, in case 5, holmium laser was preferred [ 20 ].…”