Bronchoscopic Carbon Dioxide Laser Surgery

Abstract

Endotracheal and endobronchial carbon dioxide laser surgery can be carried out using standard ventilating bronchoscopes, a recently developed laser endoscope attachment and a 50W CO2 surgical laser unit. General anesthesia, using nonflammable anesthetics, is delivered through the side arm of the ventilating bronchoscope; the tidal flow of gases keeps the trachea and bronchi free of steam and smoke. The technique has been particularly helpful in the bloodless removal of recurrent papillomas from the trachea and main stem bronchi of ten children with tracheostomies. While three of the patients have gone into remission following laser excision, the method cannot be curative of itself. There were no complications attributable to the carbon dioxide laser surgery, per se, but constant vigilance must be exercised as with all laser surgery. As instrumentation becomes refined the technique will have wider application in the management of tracheobronchial disease.