Indications for endoscopic Nd-YAG laser surgery in the trachea and bronchus.

Nd-YAG laser surgery via the fiberoptic bronchoscope can vaporize lesions causing airway obstruction or stenosis located from the trachea to segmental bronchi with minimized danger of bleeding, and improve ventilatory disturbances. 35 lesions in the trachea and bronchus consisting of 27 malignant lesions and 8 benign lesions were treated with endoscopic Nd-YAG laser surgery. The procedures were performed under local anesthesia, and no significant side effects were recognized. The lesions was irradiated with 20-80 W. power. In most cases a continuous wave was used, but in cases of early stage squamous cell carcinoma intermittent irradiation of 0.5 second laser spots were used. In 21 of 35 cases effective results were obtained. The non-effective results obtained in 14 cases were considered to be due to inexact preprocedural evaluation of the extent of the lesions. Effective results were obtained in 11 of 13 lesions located in the trachea, in 3 of 5 lesions in the trachea and bronchus and in 7 of 17 lesions in the bronchus. Tumor in the trachea with severe ventilatory disturbance is a good indication for Nd-YAG laser surgery to rapidly alleviate symptoms. But in cases of lung cancer, indications even as a palliative procedure are limited to those cases in which the lung parenchyma distal to the stenotic portion is viable. However, the indications for this procedure as a curative modality are extremely limited.