Endoscopic Nd : YAG Laser Treatment in the Perioperative Management of ’ acheobronchoplasty TAKEHIKO FUJISAWA

The objective of this study was to determine the role of endoscopic Nd:YAG laser treatment in the preoperative or postoperative management of tracheobronchoplasty. Eighteen patients with severe stenotic lesions of the trachea or bronchus underwent Nd:YAG laser treatment. Nd:YAG laser treatment was performed in the preoperative period in 14 patients and in the postoperative period in 4 patients. The indications for Nd:YAG laser treatment included emergency airway dilatation, confirmation of the distal margin of tumor, and safe tracheal intubation in patients with severe tracheal stenosis. The indications for Nd:YAG laser treatment in patients with severe stenosis of the mainstem bronchus were confirmation of the distal margin of tumor and recovery of lung ventilation during the preoperative period and reopening of the bronchial lumen to prevent obstructive pneumonia in the postoperative period. Among patients treated with Nd:YAG laser preoperatively, the indications were completely achieved in all 14 patients, except for 1 patient with adenoid cystic carcinoma who underwent treatment of the right mainstem bronchus. Among patients treated with Nd:YAG laser postoperatively the indications also were achieved in all 4 patients with severe granulomatous stenosis of the bronchial end-to-end anastomosis following sleeve lobectomy. In conclusion, endoscopic Nd:YAG laser treatment played an important role in the perioperative management of patients undergoing tracheobronchoplasty.