Laser bronchoscopy.

The worldwide epidemic of cancer of the lung has stimulated the development of therapies to relieve endobronchial obstruction. Table 3 lists a number of endobronchial therapies that might be used to treat malignant central airway obstruction. With over 15 years of worldwide experience, the Nd:YAG laser has proven to be the most important of these tools. Laser bronchoscopy can be performed with rigid or flexible instruments and produces a rapid recanalization of the airway with associated relief of symptoms. The treatment is repeatable and has acceptable immediate complications and infrequent delayed complications. To be effective, laser bronchoscopy can only be used for the treatment of intraluminal obstructions. Obstruction by submucosal infiltration and external compression require other endobronchial therapies. The performance of laser bronchoscopy requires an extra commitment by the bronchoscopist. A thorough understanding of airway and mediastinal anatomy is mandatory along with an appreciation of laser physics and tissue interaction. Attendance at specialized training courses may be required to satisfy local credentialing bodies. In the past 15 years, thousands of patients have benefited from the development of laser bronchoscopy techniques. No longer a therapy of last resort, laser bronchoscopy has proven to be an excellent tool to relieve the symptoms of central airway obstruction.