New applications of the laser in pulmonary surgery: hemostasis and sealing of air leaks.

In thoracic surgery, the laser has been used primarily as a destructive instrument (e.g., for extirpation of endobronchial lesions and for skin incisions). Previously, the carbon dioxide laser was used for its scalpel-like action but not for sealing. The neodymium:yttrium aluminum garnet (Nd:YAG) laser not only cuts but also seals blood vessels and bronchi. We have modified the CO2 laser technique to seal vessels and bronchi up to 3 mm on a cut surface by using low power in a defocused mode, and have evaluated the method in 12 dogs. Matched lesions in the lingula were sealed with each type of laser and compared with lesions closed by suture technique. These lesions were then evaluated at biweekly intervals up to 6 weeks following operation. All lesions demonstrated substantial air leak and bleeding prior to sealing. There was no bleeding or air leak (40 cm H2O of pressure) at any time after sealing (laser or suture). The CO2 laser sealing consistently produced the least damage both macroscopically and microscopically. However, this technique requires a relatively bloodless field. The Nd:YAG laser produced the deepest tissue destruction but functioned well under conditions of poor hemostasis. Suture closure produced large early injuries, which subsided gradually to approach the amount of damage seen with the CO2 laser. These studies demonstrate that the laser may be a useful adjunct to maximally preserve normal lung tissue and to seal bleeding, leaking, raw lung surfaces. Results of early clinical trials are also detailed.