Tracheobronchial obstructive lesions cause significant patient discomfort and increased morbidity. The Holmium-YAG laser has a depth of penetration and optic visualization that allows precise and controlled ablation of tissue. This is the largest case series describing the application of Holmium-YAG laser for tracheobronchial obstructive disease.
A retrospective analysis of patients undergoing surgical treatment of tracheobronchial obstruction from benign and malignant conditions. The study period was over 28 months. We utilized flexible bronchoscopy and Holmium-YAG laser.
34 patients were treated. Average age was 55.6 ± 10.5 years (range 36-75). Twenty-seven (79%) had cancer, 18 had primary lung cancer. Seven patients had airway obstruction secondary to benign conditions. Eighty-five percent had American Society of Anesthesiologists (ASA) score of 3 or 4. Pre-operative pneumonia was present in 38% and 18% had lung consolidation. Total of 57 procedures were performed. Holmium-YAG laser was used in 46 procedures –26 laser only and 20 with laser plus stenting. There was 1 (2.9%) operative death, 30-day mortality was 6/34 (17.6%), and hospital mortality was 7/34 (20.6%). Post-operative relief of symptoms was completely determined in 22 patients. Twenty patients had immediate improvement, 1 was worse, and 1 had no change in breathing. Average hospital stay was 3.6 ± 8.4 days (range 0-59).
Patients presenting with tracheobronchial obstruction in general have poor pre-operative functional status with significant discomfort. In this select group, symptomatic relief in breathing and functional status can be provided by the application of the newer Holmium-YAG laser combined with tracheobronchial dilation and stenting.
This new technique enables a physician to open and maintain an airway that was previously inaccessible. It provides a reasonable technique that appears safe and effective.
S. Khwaja, None.