抄録
The development of current thoracoscopic surgical equipment and instrumentation allowed recent advancement of the procedures1). Among that equipment, endoscopic staplers and Nd: YAG laser were the two most important components2). Endoscopic staplers are used to separate the lung tissue, blood vessels, bronchus and so on. The cut end is safely sealed. Although they are easy to use, there are some limitations to employ the staplers. Thick tissue cannot be separated and the stapler cannot be applied on some part of the lung as diaphragmatic surface, mediastinal side near the vessels and around the pulmonary ligament. Enucleation of the nodules in the lung cannot be performed by the stapler. Nd: YAG laser with contact tip scalpel is also used to separate the tissue. The bleeding as well as the air leakage from lung parenchyma is controlled by this method and reinforced by the application of free beam Nd: YAG laser. Bleeding from the vessels and air leakage from the bronchioles must be closed by clips or suture. Though some advanced technique is required, there is almost no limitation of the separation with Nd: YAG laser method. Enucleation is possible, any part of the lung with any thickness can be separated. Another important application of the laser is to contract an emphysematous lung surface to reduce the residual volume and to normalize the static lung compliance. After the ablation of the emphysematous lung surface, the patient's lung function and clinical symptoms are improved. In conclusion, endoscopic staplers are playing the role of spreading the procedure while Nd: YAG laser does expanding the application of thoracoscopic surgery.
