Endobronchial Laser Therapy - Indications, Advantages, Complications, and Procedure

Introduction

Endobronchial laser therapy is the fastest and most reliable method. The clinical effectiveness of endobronchial laser therapy is better than bronchoscopy. The laser used in endobronchial laser therapy can penetrate any type of lesion and tissue. YAG (Yttrium aluminum garnet) laser is commonly used in endobronchial laser therapy. The laser intensity depends upon the blood supply and tissue type treated under endobronchial laser therapy.

The relapsing rate of tracheal stenosis is very low if treated with endobronchial laser therapy. The cost of endobronchial laser therapy is relatively higher than that of normal bronchoscopy. It cannot be done in patients who have placed stents for cardiac issues.

What Are the Indications of Endobronchial Laser Therapy?

• Restrictive Lung Disease - Patients with restrictive lung disease have more narrowed airways. Endobronchial laser therapy is used to open up the airways.

• Tumor - The enlarged tumor blocks the air passages and causes shortness of breath (dyspnea). Endobronchial laser therapy removes the lesions in the throat and nose and clears the airway. It is used to remove the tumor in large fragments. It is used to remove both cancerous and non-cancerous lesions.

• Bronchiolar Disease - It can reach the bronchioles without any intervention. So, endobronchial laser therapy can easily approach the lesions associated with the tiny air sacs.

• Pulmonary Cyst - It is used to remove hemorrhagic cysts present in the lungs. A laser is also used to coagulate the tumor with the rigid bronchoscope before removing it.

• Tracheal Stenosis - The incision made in the windpipe during tracheostomy may cause narrowing of the trachea. This can be rectified using endobronchial laser therapy.

• Tracheobronchomalacia - The collapsing of the windpipe and bronchial tubes leads to tracheobronchomalacia. It is treated with endobronchial laser therapy.

• Adenoid Cystic Carcinoma - It is commonly seen in the salivary glands. The cancerous tissue is removed using endobronchial laser therapy.

• Adenoma and Lipoma - The non-cancerous lesions like adenoma and lipoma present in the parathyroid glands and soft tissues, respectively, are removed using endobronchial laser therapy.

What Are the Advantages of Endobronchial Laser Therapy?

• The healing rate is much faster than the bronchoscopy.

• It prevents the aspiration of debris, smoke, and tumor fragments by eliminating the complete tumor, especially in the trachea and bronchi.

• Endobronchial laser therapy can be used contactless, thus reducing the injury to the adjacent tissues.

• Endobronchial laser therapy is a minimally invasive technique when compared to bronchoscopy.

What Are the Instructions to Follow Before and After the Endobronchial Laser Therapy?

• The patient should not eat food or drink liquids for two hours before and after the endobronchial laser therapy.

• Avoid vigorous activities like weight lifting and running.

• Do not cough or sneeze vigorously to avoid complications.

• Consult the doctor if there are any blood streaks while vomiting after the endobronchial laser therapy.

• The area near the throat and mouth may feel numb due to the anesthetic spray for a few hours after endobronchial laser therapy.

• Provide the information on medical reports and the medications to the surgeon before endobronchial laser therapy because blood-thinning drugs can create complications.

• The surgeon prescribes steroids before endobronchial laser therapy.

• Endobronchial laser therapy lasts for around 30 to 40 minutes. There is mild discomfort after the therapy.

• Lozenges are prescribed after endobronchial laser therapy to prevent sore throat.

• The patient should go for review after two weeks of endobronchial laser therapy.

How Is Endobronchial Laser Therapy Performed?

• General anesthesia is given before endobronchial laser therapy.

• The patient and the operator should wear a special glass to protect the eyes from the laser beams during endobronchial laser therapy.

• A laser is also attached to a traditional bronchoscope during the procedure. This is known as laser-assisted bronchoscopy.

• The surgeon passes the bronchoscope into the throat using video assistance. It is also attached with light for clear visualization.

• The tissue is retracted using a tool, and the laser is generated over the lesion.

• The laser used in endobronchial laser therapy has a power of 30 to 45 watts.

• The lesion is treated intermittently with the laser beam. It is delivered in the interval of 0.5 to one second. Then, the laser penetrates deep into the tissue.

• There is less gagging reflex in endobronchial laser therapy.

What Are the Complications Associated With Endobronchial Laser Therapy?

Endobronchial laser therapy has serious complications associated with it. They are as follows:

• Hypoxia - When a lesion is treated using endobronchial laser therapy, it reduces the oxygen supply of the adjacent tissues.

• Pleural Effusion - There may be profuse bleeding after the endobronchial laser therapy. It may occur on the external surface of the lungs and cause pleural effusion.

• Necrosis - A high temperature is required during endobronchial laser therapy. It may also lead to necrosis of the underlying tissue.

• Perforation - There is a high risk of perforating the major artery while removing the lesion using endobronchial laser therapy.

• Cardiac Arrest - If the main arterial supply of the artery thickens after the endobronchial laser therapy, it causes increased heartbeat and eventually ends in cardiac arrest.

• Pneumothorax - The potential damage to the structures present in the mediastinum during endobronchial laser therapy can lead to pneumothorax. But it is a rare condition.

• Emphysema - The tiny air sacs may rupture due to the increased temperature during endobronchial laser therapy. It results in emphysema.

• Respiratory Failure - Since endobronchial laser therapy results in decreased oxygen flow, it can lead to respiratory failure.

• Gas Emboli - If there is an air entrapment inside the pulmonary vein during endobronchial laser therapy, it might end in gas emboli.

Conclusion

The major lesions require more exposure, so there is an increased duration. A skillful surgeon can perform endobronchial laser therapy without excessive bleeding. So, the lesion must be properly devascularized before the surgery. If the patient is on supplemental oxygen therapy, the oxygen flow is reduced to 50 percent during the endobronchial laser therapy. More laser beams pass through pale lesions than those with rich blood supply. Fever, cough, and throat swelling after the endobronchial laser therapy indicate infection. It requires medical attention at an earlier stage.