New uses of the laser in thoracic and cardiovascular surgery.

Lasers have been accepted in general thoracic surgery as resectional tools which allow precise hemostasis and maximal salvage of normal lung tissue. Used endoscopically, with or without associated photodynamic therapy, we have provided acceptable palliation in some patients with obstructing tumors of the tracheobronchial tree and esophagus. Cardiovascular uses of the laser have been under extensive investigation at our medical center for many years. We have demonstrated that laser-assisted anastomosis of small vessels is possible, that early tensile strength and patency are excellent, but that long-term aneurysm formation is excessive. In addition, CO2 laser injury of the arterial intima leads to a marked increase in atheromata formation in animal models of atherosclerosis; this may be eliminated with the excimer laser. We have begun using the excimer laser to open obstructed peripheral and coronary arteries. New technology is emerging which allows dual fiber catheters which allow identification of tissue in an artery, ie calcium, atheromata, clot, media, etc. and instantaneous computer sensing/integration which initiates "fire" or "no fire" signals in the enclosed laser system, thus decreasing the chance of vessel perforation. These technologies, in association with balloon angioplasty, intravascular stents, and atherectomy devices are offering exciting alternate therapy for patients with obstructing atherosclerosis.