Use of the carbon dioxide laser for tracheobronchial lesions in children.

IMPORTANCE

Obstructing tracheobronchial diseases in children can be treated by a variety of techniques. The nonfiberoptic delivery of the carbon dioxide laser coupled to a rigid bronchoscope has rarely been described for this purpose and has unique advantages over other treatment methods.

OBJECTIVES

To report the indications, safety, efficacy, and limitations of the carbon dioxide laser delivered through a rigid bronchoscope for tracheobronchial lesions in the pediatric population.

DESIGN

Case series of patients undergoing treatment for tracheobronchial lesions at a single institution from December 2, 2001, through December 14, 2011.

SETTING

Tertiary care children's hospital.

PARTICIPANTS

Seventeen patients aged 3 months to 17 years with endotracheal and endobronchial disease.

INTERVENTION

Carbon dioxide laser treatment through a rigid bronchoscope.

MAIN OUTCOME MEASURES

Reduction in tumor burden or improvement of ventilation.

RESULTS

A total of 234 laser bronchoscopies were performed on 17 patients. Mean operative time was 29 (range, 2-89) minutes. Blood loss and complications were minimal. Sixteen patients received carbon dioxide laser delivered through a rigid bronchoscope with a proximal coupler or flexible fiber. The most common indication was tracheobronchial granulation tissue (n = 10), followed by prolapsed cartilage causing tracheal obstruction (n = 3), recurrent respiratory papillomatosis (n = 2), and granular cell tumor (n = 1). Of these patients, 15 (94%) underwent successful treatment. One patient was treated electively with the Nd:YAG laser owing to a vascular malformation.

CONCLUSIONS AND RELEVANCE

The carbon dioxide laser delivered through a rigid bronchoscope is a suitable tool for managing nonvascular endotracheal and endobronchial lesions in the pediatric population. Its unique wavelength properties offer a safe, effective alternative to other lasers and open resection.