Use of the KLS Martin Nd:YAG laser MY 40 1.3 in Lung Parenchyma Surgery

Overview

Introduction:
Nd:YAG laser MY 40 1.3 has been developed to be employed in lung tumor resections. The method’s principle is based on tissue absorption of light energy and its transformation into heat. The light beam wavelength is 1318 nm and its output power is 40 W. The beam even penetrates fluid media up to the depth of 6mm, and its hemostatic effect is much larger than in other models (obstruction of arteries of up to 2 mm in diameter, veins of up to 3 mm in diameter). The laser beam application to the lung parenchyma is continuous and non-contact.

Aim:
Analysis of our initial experience with the use of the instrument in surgical management of primary and secondary lung tumors.

Methodology:
From March 2008 to December 2008, the authors operated 12 male and 5 female patients, the average age was 60.7 years. In 12 subjects, lung metastases of malignant tumors were detected, 3 subjects suffered from primary lung carcinoma and two from benign lung lesions. 7 operated subjects had multiple secondary lung tumors in various lobes of a single lung or both lungs, in 5 subjects, the secondary tumors were solitary. Most commonly – in 7 cases, the subjects suffered from colorectal carcinoma metastases. All the above surgical procedures were performed under general anesthesia with selective lung ventilation via posterolateral thoracotomy.

Results:
In the all 12 patients, the lung metastases were radically removed using parenchyma-saving laser metastasectomy. In 3 subjects with primary pulmonary carcinoma, the laser was used to perform limited resection for intraoperative biopsy purposes, which was followed by standard radical pulmonary resection. The two benign lesions were managed in a similar way. Perioperative morbidity and mortality was nil, no significant air leak was recorded in the subjects during the postoperative period.

Conclusion:
Nd:YAG laser MY 40 1.3 facilitates radical removals of secondary pulmonary neoplasms, in particular of the multiple and deeply located ones, with no need for extensive lung parenchyma resections and with minimum intraoperative morbidity and mortality rates. Furthermore, it can be successfully used in a numer of other surgical procedures, such as management of pleural adhesions, lung biopsies, resections of emphysematous bullae, resections of benign lung tumors, dissections of inerlobal fissures, etc., where the method can fully replace staplers. It has potential for its further application in miniinvasive pulmonary surgery in the near future.

Key words:
Nd: YAG laser MY 40 1.3 – metastasectomy – air-leak – hemostasis