Basic and clinical studies using laser cutters in lung surgery

Abstract

The authors compared the results of partial pulmonary resection using 3 types of laser cutters in a total of 32 adult mongrels. The laser cutters consisted of a carbon dioxide gas laser, an argon ion laser and a YAG laser. The results were compared macroscopically and microscopically and on their basis the instruments were employed in clinical cases and their characteristics further evaluated.
The CO₂ gas cutter at a power output of 40W showed cutting characteristics resembling those of the conventional scalpel and had the least effect on surrounding tissue of the three. However its hemostatic ability was limited and the jointed surgical arm has the drawback of rendering it difficult to manipulate easily intrathoracically. Although the argon ion laser provided effective hemostasis its cutting characteristics were poor and it did not qualify for employment as a cutting instrument. While the YAG laser was slightly less effective than the CO₂ laser in terms of cutting characteristics it provided excellent hemostasis and the effect on surrounding tissue was also low. It was recognized as the most suitable instrument of the three types of lasers for employment in lung surgery.
On the basis of clinical experience the following points were recognized to be important when performing pulmonary resection with laser cutters:
1. The blood vessels in the hilar region should be compressed to reduce blood flow.
2. The vessels which are roentgenologically recognized as being involved with the tumor should be occluded as quickly as possible.
3. Alveoli and bronchioles are cauterized easily but larger bronchi and blood vessels remain in a string-like condition. They should be ligated then transected.