Laser resection of lung metastasis

Abstract

Presentation of the laser resection technique for metastatic lung diseases: a new Nd:YAG 1.318 nm wavelength laser system enables the thoracic surgeon to extend indication and include a larger number of patients for pulmonary metastasectomy. This parenchyma-saving technique allows removal of a significantly higher number of lung nodules in comparison to conventional techniques (stapler, clamp resection). The novel laser system consisted of a high performance Nd:YAG laser emitting the 1318 nm wavelength exclusively up to a power of 40 W, thin flexible quartz fibers (400 μm) with low water content and a four-lens focusing handpiece. Description of laser system, the technique of laser resection, together with an overview of the literature is presented.

Laser resection technique and results of multiple lung metastasectomies using a new 1,318 nm Nd:YAG laser system

“…Metastasectomy can be performed more aggressively using the 1,318 nm laser as seen by the presence 22% benign lesions resected simultaneously with true metastases, a fact not yet reported by other groups but which must occur frequently given the nature of any operation based on palpating small lung nodules [9,18]. When complete resection was achieved, a 5-year survival of 41% similar to other groups was observed for all patients but no significant poorer outcome was seen for associated lymph node disease and bilateral resections.…”

“…For further transmission to the lung in the thoracic cavity a four lens focussing handpiece was developed allowing a nearly one-to-one projection of the focus. Last but not the least, a high-performance evacuation system is needed for rapid removal of the plume produced during photothermal laser resection [6,8,9].…”

“…Only in the center of a lobe, at the level of segmental arteries and bronchi with diameters of 3 mm and more, is a suture of these structures necessary. For reconstruction of the lobe with several large laser resection areas and for creation of a new pleural surface we perform a running suture to reapproximate the cut edges of the pleura [9,10].…”

Laser-Assisted Resection of a Giant Pulmonary Chondrohamartoma - A Case Report

“…For the technical details of the laser resection see http://mmcts. ctsnetjournals.org/cgi/collection/surgery_metastatic_lung [5]. After division of the two lobes, exposition of the central vessels and bronchial structures, a standard lower lobectomy was performed.…”

“…For larger lesions, anatomical lung resection is necessary. Laser resection for multiple pulmonary metastases is already a standard, established procedure with a low mortality and morbidity [5,6]. The use of a laser system with its sparing effect on lung parenchyma is the treatment of choice for multiple lung nodules [5 -7].…”