Use of a 1318 nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis
-
Alexander V. Bashenow
,
Igor Y. Motus
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.
Zusammenfassung
Ziel:
Es wird über erste Erfahrungen beim Einsatz eines 1318 nm Nd:YAG-Lasers für die Operation begrenzter Formen der Lungentuberkulose berichtet.
Patienten und Methode:
In der Zeit von Juni 2013 bis August 2015 wurden insgesamt 32 Patienten (19 Männer und 13 Frauen) einer chirurgischen Resektion tuberkulöser Granulome unterzogen. Das Durchschnittsalter der Patienten betrug 37,3 Jahre (Median: 36 Jahre, Altersbereich: 18–61 Jahre). Die Resektion der Granulome erfolgte entweder nur mit dem Laser (25 Patienten) oder in Kombination mit chirurgischen Klammernahtgeräten (7 Patienten).
Ergebnisse:
Bei den 32 Patienten wurden insgesamt 39 Tuberkulome entfernt. Das größte war 2,4×2,2×3,1 cm groß, das kleinste 0,5×0,5×0,5 cm. Insgesamt betrug die durchschnittliche Operationszeit 57 min (Median: 50 min; Bereich: 25–115 min). In der kombinierten Resektionsgruppe (mit dem Laser und Tacker) lag die durchschnittliche Operationszeit bei 75 min (Median: 50 min; Bereich: 45–115 min). In der Gruppe wo die Lungenresektion allein mit dem Laser durchgeführt wurde, betrug die durchschnittliche Operationszeit 52 min (Median: 45 min; Bereich: 25–95 min). Der Gesamtblutverlust während der Operation lag bei 53 ml (Median: 45 ml; Bereich: 10–150 ml); 87 ml (Median: 50 ml, Bereich: 15–150 ml) in der kombinierten Lungenresektionsgruppe und 44 ml (Median: 35 ml; Bereich: 10–100 ml) in der Lasergruppe. Die morphologische Analyse der resektierten tuberkulösen Granulome ergab ein hohes Maß an tuberkulöser Aktivität in 12/39 (31%) Fällen, ein moderates Maß an tuberkulöser Aktivität in 11/39 (28%) Fällen und eine remittierende Aktivität in 16/39 (41%) Fällen. Entlang der Laser-Resektionslinie der Lunge wurden in 10/39 Fällen (26%) noch Reste tuberkulösen Wachstums gefunden. Die durchschnittliche postoperative Dauer der Pleuradrainage betrug insgesamt 3,9 Tage (Median: 3 Tage; Bereich: 2–9 Tage); 4,1 Tage (Median: 5 Tage, Bereich: 2–6 Tage) in der kombinierten Untergruppe und 3,8 Tage (Median: 3 Tage; Bereich: 2–9 Tage) in der Lasergruppe. Die Zahl der postoperativen Komplikationen nach der Clavien-Dindo-Skala betrug 2 von 32 Patienten (6,2%), mit 2 Fällen einer verbliebenen pleuralen Kavität. Die postoperative Mortalität betrug 0%.
Fazit:
Unsere ersten Erfahrungen mit dem 1318 nm Nd:YAG-Laser für die Resektion von begrenzten Formen der Tuberkulose zeigten eine hohe Wirksamkeit und ausgezeichnete Aero- und hämostatische Eigenschaften mit einer niedrigen Rate postoperativer Komplikationen, wenngleich die Unterschiede zwischen den beiden Behandlungsgruppen (Laser allein oder in Kombination mit einem chirurgischen Tacker) statistisch nicht signifikant waren (p>0,05). Jedoch ist das Verfahren in der Chirurgie begrenzter Formen von Lungentuberkulose in verschiedenen Varianten anwendbar, für reine Laserresektionen oder als zusätzliches Verfahren für andere Arten von Lungenresektionen.
Acknowledgments
We would like to express our sincere thanks to Mr. A. V. Neretin at our institution, who has proved to be a pioneer in the resection of pulmonary tuberculomas using a Limax® 120 laser system. The authors would also like to express their enormous gratitude to Dr. A. Rolle for the large number of his publications dealing with the challenges of laser use in parenchymal sparing lung surgery. It was those publications and research papers that prompted us to write this article.
Conflict of interest statement: The authors state no conflict of interest. All authors have read the journal’s Publication Ethics and Publication Malpractice Statement available at the journal’s website and hereby confirm that they comply with all its parts applicable to the present scientific work.
References
[1] Minton JP, Andrews NC, Jesseph JE. Pulsed laser energy in the management of multiple pulmonary metastases. J Thorac Cardiovasc Surg 1967;54(5):707–13.10.1016/S0022-5223(19)43044-4Suche in Google Scholar
[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):546–50.10.1016/S0003-4975(10)60346-3Suche in Google Scholar
[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):87–94.10.1016/S1010-7940(88)80004-6Suche in Google Scholar
[4] LoCicero 3rd J, Frederiksen JW, Hartz RS, Michaelis LL. Laser-assisted parenchyma-sparing pulmonary resection. J Thorac Cardiovasc Surg 1989;97(5):732–6.10.1016/S0022-5223(19)34518-0Suche in Google Scholar
[5] Moghissi K. Local excision of pulmonary nodular (coin) lesion with noncontact yttrium-aluminum-garnet laser. J Thorac Cardiovasc Surg 1989;97(1):147–51.10.1016/S0022-5223(19)35140-2Suche in Google Scholar
[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 977–8.10.1016/0003-4975(91)91021-MSuche in Google Scholar
[7] Rolle A. Laser applications in lung parenchyma surgery. Med Laser Appl 2003;18(4):271–80.10.1078/1615-1615-00114Suche in Google Scholar
[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):546–51.10.1002/lsm.1900060614Suche in Google Scholar
[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. 159–63.10.1007/978-3-642-72870-9_39Suche in Google Scholar
[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.Suche in Google Scholar
[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):865–9.10.1016/S0003-4975(02)03805-5Suche in Google Scholar
[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):26–32.10.1002/lsm.20259Suche in Google Scholar
[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):187–96.10.1097/SLA.0b013e3181b13ca2Suche in Google Scholar
[14] Gelb AF, Epstein JD. Neodymium-yttrium-aluminum-garnet laser in lung cancer. Ann Thorac Surg 1987;43(2):164–7.10.1016/S0003-4975(10)60388-8Suche in Google Scholar
[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 948–9.10.1016/S0003-4975(01)03417-8Suche in Google Scholar
[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):758–61.10.1016/0003-4975(93)90974-MSuche in Google Scholar
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Light and lasers for vascular and skin diseases: From bench to clinic – An update
- Magazine section
- Snapshots
- Original contributions
- A study on the effects of 532 nm continuous laser combined with photodynamic therapy versus 595 nm pulsed dye laser on a chicken comb model of vascular malformation
- Calibration of a three-dimensional photodynamic therapy illumination system and its segmentation assessment for port-wine stains
- In-vitro effect of antimicrobial photodynamic therapy with methylene blue in two different genera of dermatophyte fungi
- Low-level laser therapy enhances muscle regeneration through modulation of inflammatory markers
- Case reports
- Treatment of recalcitrant viral warts using a 577-nm wavelength high-power optically pumped semiconductor laser
- Can laser therapy be the answer for radiodermatitis in anal cancer patients? Two case reports
- Use of a 1318 nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis
- Congress announcements
- Congresses 2016/2017
Artikel in diesem Heft
- Frontmatter
- Editorial
- Light and lasers for vascular and skin diseases: From bench to clinic – An update
- Magazine section
- Snapshots
- Original contributions
- A study on the effects of 532 nm continuous laser combined with photodynamic therapy versus 595 nm pulsed dye laser on a chicken comb model of vascular malformation
- Calibration of a three-dimensional photodynamic therapy illumination system and its segmentation assessment for port-wine stains
- In-vitro effect of antimicrobial photodynamic therapy with methylene blue in two different genera of dermatophyte fungi
- Low-level laser therapy enhances muscle regeneration through modulation of inflammatory markers
- Case reports
- Treatment of recalcitrant viral warts using a 577-nm wavelength high-power optically pumped semiconductor laser
- Can laser therapy be the answer for radiodermatitis in anal cancer patients? Two case reports
- Use of a 1318 nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis
- Congress announcements
- Congresses 2016/2017
