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Communications to the Editor |

Electrocautery in Endobronchial Therapy FREE TO VIEW

Robert G. Hooper, MD, FCCP
Author and Funding Information

Affiliations: Scottsdale, AZ,  Academic Hospital Free University Amsterdam, The Netherlands

Correspondence to: Robert G. Hooper, MD, FCCP, PO Box 4100, Scottsdale, AZ 85261-4100



Chest. 2000;117(6):1820-1821. doi:10.1378/chest.117.6.1820
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Published online

To the Editor:

Dr. van Boxem et al (October 1999)1 should be complimented on their efforts to promote electrocautery and on their analysis of the relative cost of endobronchial treatments. My personal experience, in an institution that employed electrocautery, Nd-YAG laser, and brachytherapy, supports their conclusion that the cost of electrocautery is small in comparison to other endobronchial techniques. However, I believe that the reasons why electrocautery did not catch on, after our initial reports of its success, are more complicated than those which they proposed.

We began using electrocautery to treat endobronchial disease when no other endobronchial method was available.2In the early 1980s, patients seeking treatment often were referred to us because of the lack of any other options for rapid treatment. Our initial experience grew simply from an apparent need and a lack of alternatives. At the same time, the Nd-YAG laser was being readied for release. Publications from academic institutions supported the effectiveness of the Nd-YAG laser. Our second article on electrocautery was published in 1985, just after the release of the Nd-YAG for clinical use, and our last report followed in 1988.34 Despite the benefits experienced, there was little enthusiasm for electrocautery. By that time, the laser decade had begun for the pulmonary community in the United States.

After Nd-YAG lasers were released for clinical use, they rapidly became widely available. Courses for physicians on laser therapy began, as well as promotions by equipment manufacturers. Locally, the laser and its magic caught on like wildfire. Physicians and patients alike were enamored of the new technology. Referrals decreased as new lasers were installed. Some of the original authors of our work were never to use electrocautery again. Nationally, no academic institutions studied electrocautery.

The paradigm of endobronchial therapy for the next decade was set by the favorable view that physicians, patients, academic programs, and equipment manufacturers focused on the Nd-YAG laser technology. Electrocautery was left for another time, its role unconfirmed and uncertain. Maybe the time for serious assessment has come.

References

van Boxem, T, Muller, M, Venmans, B, et al (1999) Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction.Chest116,1108-1112. [CrossRef] [PubMed]
 
Hooper, RG, Spratling, L, Beechler, CR, et al Endobronchial electrocautery: a role in bronchogenic carcinoma.Endoscopy1984;16,67-70. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1985;87,712-714. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1988;94,595-598. [CrossRef] [PubMed]
 
To the Editor:

We thank Dr. Hooper, in his letter above, for the positive comments on our article,1 and the additions to the reasons why electrocautery did not become a popular technique in endobronchial therapy. We agree that the assessment of bronchoscopic electrocautery was seriously handicapped at that time by the popularity and magic of laser. Unfortunately, Dr. Hooper practiced during that particular period when Nd-YAG laser was so immensely popular, and the magic of laser was so difficult to resist, that the necessity for randomized trials and further in-depth investigations were not considered necessary.

I personally believe that even in the field of medicine there is some influence by current fashion from time to time, despite our persistent devotion to hard, objective data in randomized, placebo-controlled, clinical trials. Costs of treatment and equipment were perhaps not such critical issues in earlier days. Although we also agree that it is time for serious assessment of well-designed, randomized, phase III trials, performed by unprejudiced physicians, to give definite answers to the questions that remain, we currently lack any prospect of support to conduct such a trial. The tragedy is that while some health insurance companies in The Netherlands are severely cutting costs of managed care by specialists, they do cover expenses for alternative medicine.

I thank Dr. Hooper for his article back in 1985 in CHEST,2 which ultimately convinced me, in 1989, after observing that Nd-YAG laser was not frequently used in The Netherlands despite many centers having the facility, that other factors may be equally important for the clinical practice. While it does not always “sell” very well, I am lucky to practice in The Netherlands, where the attitude is “thrifty” and sober.

References
van Boxem, T, Muller, M, Venmans, B, et al Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study.Chest1999;116,1108-1112. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1985;87,712-714. [CrossRef] [PubMed]
 

Figures

Tables

References

van Boxem, T, Muller, M, Venmans, B, et al (1999) Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction.Chest116,1108-1112. [CrossRef] [PubMed]
 
Hooper, RG, Spratling, L, Beechler, CR, et al Endobronchial electrocautery: a role in bronchogenic carcinoma.Endoscopy1984;16,67-70. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1985;87,712-714. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1988;94,595-598. [CrossRef] [PubMed]
 
van Boxem, T, Muller, M, Venmans, B, et al Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study.Chest1999;116,1108-1112. [CrossRef] [PubMed]
 
Hooper, RG, Jackson, FN Endobronchial electrocautery.Chest1985;87,712-714. [CrossRef] [PubMed]
 
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