Use of a 1318 nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis

Alexander V. Bashenow 1 , Igor Y. Motus 2 , Sergey N. Skornyakow 2 , Anton V. Neretin 3 , Natalya V. Rayewskaya 2 , Ilia A. Dyachkow 2 , Roman B. Berdnikow 2 ,  and Lyudmila A. Golubewa 2
  • 1 Ural Research Institute for Phthisis pulmonology – Lung surgery, XXII Parts’ezda 50, Ekaterinburg 620039, Russian Federation
  • 2 Ural Research Institute for Phthisis pulmonology, XXII Parts’ezda 50, Ekaterinburg 620039, Russian Federation
  • 3 TB Dispensary of Sverdlovsk region, Chapaeva 9, Ekaterinburg 620142, Russian Federation
Alexander V. Bashenow, Igor Y. Motus, Sergey N. Skornyakow, Anton V. Neretin, Natalya V. Rayewskaya, Ilia A. Dyachkow, Roman B. Berdnikow and Lyudmila A. Golubewa

Abstract

Objective:

A first experience of using a Nd:YAG laser with a wavelength of 1318 nm for limited forms of pulmonary tuberculosis surgery is reported.

Subjects and methods:

During the period from June 2013 to August 2015 a total of 32 patients (19 men and 13 women) underwent surgery for tuberculous granulomas. The average age of the patients was 37.3 years (median, 36 years; range, 18–61 years). Resections of granulomas were carried out using the laser alone (25 patients) or in combination with suturing devices (seven patients).

Results:

Overall 39 tuberculomas were removed from the 32 patients. The biggest growth measured 2.4×2.2×3.1 cm, while the smallest measured 0.5×0.5×0.5 cm. Overall, the average surgery time was 57 min (median, 50 min; range, 25–115 min). In the combined resection subgroup (using the laser and staplers), the average surgery time was 75 min (median, 50 min; range, 45–115 min). In the subgroup where lung resection was carried out using the laser alone, the average surgery time was 52 min (median, 45 min; range 25–95 min). Total blood loss during surgery was 53 ml (median, 45 ml; range 10–150 ml), 87 ml (median, 50 ml; range 15–150 ml) in the combined lung resection subgroup and 44 ml (median, 35 ml; range, 10–100 ml) in the laser only resection subgroup. Morphological analysis revealed the following results: a high level of tubercular activity was maintained in 12/39 (31%) resected tuberculous granulomas, a moderate level of tubercular activity was detected in 11/39 (28%) resected masses and remitting activity was identified in 16/39 (41%) resected masses. Along the laser resection line of the lung the edge of a tuberculous growth was found in 10/39 cases (26%). The average post-operative duration of pleural drainage was 3.9 days (median, 3 days; range, 2–9 days) in total, 4.1 days (median, 5 days; range, 2–6 days) in the combined subgroup and 3.8 days (median, 3 days; range, 2–9 days) in the laser-only subgroup. The number of post-operative complications assessed according to the Clavien-Dindo scale was two out of 32 patients (6.2%), with two cases of residual pleural cavities. Post operative mortality was 0%.

Conclusion:

Our first experience of using the Nd:YAG laser with a wavelength of 1318 nm for the resection of limited forms of tuberculosis demonstrated a high level of efficacy and excellent aero- and hemostatic properties with a low rate of post-operative complications even though the differences between the combined resection and laser-only subgroups were not statistically significant (p>0.05). However, the method is applicable in surgery of limited forms of lung tuberculosis in different variants, performing pure laser resections and as an additional method for other types of lung resections.

  • [1]

    Minton JP, Andrews NC, Jesseph JE. Pulsed laser energy in the management of multiple pulmonary metastases. J Thorac Cardiovasc Surg 1967;54(5):707–13.

    • Crossref
    • PubMed
    • Export Citation
  • [2]

    LoCicero 3rd J, Hartz RS, Frederiksen JW, Michaelis LL. New applications of the laser in pulmonary surgery: hemostasis and sealing of air leaks. Ann Thorac Surg 1985;40(6):546–50.

    • Crossref
    • PubMed
    • Export Citation
  • [3]

    Moghissi K, Dench M, Goebells P. Experience in non-contact Nd YAG laser in pulmonary surgery. A pilot study. Eur J Cardiothorac Surg 1988;2(2):87–94.

    • Crossref
    • PubMed
    • Export Citation
  • [4]

    LoCicero 3rd J, Frederiksen JW, Hartz RS, Michaelis LL. Laser-assisted parenchyma-sparing pulmonary resection. J Thorac Cardiovasc Surg 1989;97(5):732–6.

    • Crossref
    • PubMed
    • Export Citation
  • [5]

    Moghissi K. Local excision of pulmonary nodular (coin) lesion with noncontact yttrium-aluminum-garnet laser. J Thorac Cardiovasc Surg 1989;97(1):147–51.

    • Crossref
    • PubMed
    • Export Citation
  • [6]

    Landreneau RJ, Hazelrigg SR, Johnson JA, Boley TM, Nawarawong W, Curtis JJ. Neodymium:yttrium-aluminum garnet laser-assisted pulmonary resections. Ann Thorac Surg 1991;51(6):973–7; discussion 977–8.

    • Crossref
    • PubMed
    • Export Citation
  • [7]

    Rolle A. Laser applications in lung parenchyma surgery. Med Laser Appl 2003;18(4):271–80.

    • Crossref
    • Export Citation
  • [8]

    Frank F, Beck OJ, Hessel S, Keiditsch E. Comparative investigations of the effects of the neodymium:YAG laser at 1.06 microns and 1.32 microns on tissue. Lasers Surg Med 1987;6(6):546–51.

    • Crossref
    • PubMed
    • Export Citation
  • [9]

    Rolle A, Unsöld E, Ruprecht L, Permanetter W, Frank F. Morphologic aspects of Nd:YAG laser application on lung tissue. In: Waidelich W, Waidelich R, editors. LASER Optoelectronics in Medicine. Berlin and Heidelberg: Springer-Verlag; 1988, p. 159–63.

    • Crossref
    • Export Citation
  • [10]

    Rolle A, Thetter O, Häussinger K, Hallfeldt KKJ, Schmölder A. Einsatz des Neodym YAG Lasers in der Thoraxchirurgie. Herz Gefäss Thorax Chir 1989;3:85–91.

  • [11]

    Rolle A, Koch R, Alpard SK, Zwischenberger JB. Lobe-sparing resection of multiple pulmonary metastases with a new 1318-nm Nd:YAG laser – first 100 patients. Ann Thorac Surg 2002;74(3):865–9.

    • Crossref
    • PubMed
    • Export Citation
  • [12]

    Rolle A, Pereszlenyi A, Koch R, Bis B, Baier B. Laser resection technique and results of multiple lung metastasectomies using a new 1,318 nm Nd:YAG laser system. Lasers Surg Med 2006;38(1):26–32.

    • Crossref
    • PubMed
    • Export Citation
  • [13]

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–96.

    • Crossref
    • PubMed
    • Export Citation
  • [14]

    Gelb AF, Epstein JD. Neodymium-yttrium-aluminum-garnet laser in lung cancer. Ann Thorac Surg 1987;43(2):164–7.

    • Crossref
    • PubMed
    • Export Citation
  • [15]

    Kiriyama M, Fujii Y, Yamakawa Y, Fukai I, Yano M, Kaji M, Sasaki H. Endobronchial neodymium:yttrium-aluminum garnet laser for noninvasive closure of small proximal bronchopleural fistula after lung resection. Ann Thorac Surg 2002;73(3):945–8; discussion 948–9.

    • Crossref
    • PubMed
    • Export Citation
  • [16]

    Landreneau RJ, Keenan RJ, Hazelrigg SR, Dowling RD, Mack MJ, Ferson PF. VATS wedge resection of the lung using the neodymium:yttrium-aluminum garnet laser. Ann Thorac Surg 1993;56(3):758–61.

    • Crossref
    • PubMed
    • Export Citation
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