For over 25 years the neodymium, yttrium, aluminum, garnet (Nd:YAG) laser has been the preferred laser for endobronchial laser therapy. A new neodymium, Yttrium, Aluminum, Perovskite(Nd:YAP) laser has been used successfully in several fields including Ophthalmology, Dentistry and Surgery. We report our experience in the use of Nd:YAP laser in the field of Interventional Pulmonology.
Retrospective review of Nd:YAP laser utilization by the interventional pulmonology service at the Lahey Clinic, Burlington,MA from November, 2007 through April 2009. A total of 25 cases were found.
The Nd:YAP Laser was used to treat the following cases:Non small cell lung cancer (NSCLC): 13 cases, Tracheobronchomalasia: 2 cases, carcinoid tumor destruction: 3 cases, endobronchial melanoma: 2 cases, tracheobronchial amyloidosis: 1 case, Post tracheostomy stenosis: 2 cases and benign airway obstruction: 2 cases.For NSCLC, the Laser was delivered through flexible bronchoscope (5 cases), rigid scope (7 cases) and combination (1 case). Airway patency was reestablished in all patients. For tracheobronchomalasia, the Laser was used through flexible bronchoscope to induce submucosal inflammation in the posterior wall of the trachea. The results were mixed. Airway patency was also successfully established in the cases of benign airway stenosis however the cutting properties of the laser were limited. The average energy used for all indications was 15Watts and no significant side effects or complications were reported.
The new Nd:YAP laser may have an important role in the field of interventional pulmonology. Its excellent coagulation properties result in effective establishment of airway patency in cases of malignant obstruction. It has a very good margin of safety. The current unit is very portable and easy to operate.
Nd:YAP laser should be considered as an option in the treatment of both malignant and benign airway obstruction. The general laser safety rules should always be followed.
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