Local excision of pulmonary nodular (coin) lesion with noncontact yttrium-aluminum-garnet laser.

Local excision of pulmonary nodular lesions with the noncontact mode of the neodymium: yttrium-aluminum-garnet laser was done in 14 patients. This was achieved through a conventional limited thoracotomy and then by evaporation/fulguration of 0.5 to 1 cm of the healthy parenchyma surrounding the lesion, which produced a bloodless incision. In 10 patients the lesion was a primary (N = 7) or secondary (N = 3) malignant tumor. The remaining four had a benign nodule. Preoperative radiology has demonstrated a solitary nodule in all 14 patients, but at operation in four patients (three with benign and one with malignant disease) there were two nodules. In each of these four patients the smaller nodule was evaporated entirely, without excision of normal pulmonary tissue. There were no hospital deaths or postoperative complications. One patient died 8 months postoperatively (carcinomatosis); the other 13 remain alive and well between 2 and 25 months after treatment. We believe that local excision of nodular pulmonary lesions with the laser should be considered whenever possible, particularly in high-risk patients, those with limited respiratory function, and in the elderly.