Use of a 1318 nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis

Abstract

Objective: A first experience of using a Nd:YAG laser with a wavelength of 1318 nm for limited forms of pulmonary tuberculosis surgery is reported. Subjects and methods: During the period from June 2013 to August 2015 a total of 32 patients (19 men and 13 women) underwent surgery for tuberculous granulomas. The average age of the patients was 37.3 years (median, 36 years; range, 18–61 years). Resections of granulomas were carried out using the laser alone (25 patients) or in combination with suturing devices (seven patients). Results: Overall 39 tuberculomas were removed from the 32 patients. The biggest growth measured 2.4×2.2×3.1 cm, while the smallest measured 0.5×0.5×0.5 cm. Overall, the average surgery time was 57 min (median, 50 min; range, 25–115 min). In the combined resection subgroup (using the laser and staplers), the average surgery time was 75 min (median, 50 min; range, 45–115 min). In the subgroup where lung resection was carried out using the laser alone, the average surgery time was 52 min (median, 45 min; range 25–95 min). Total blood loss during surgery was 53 ml (median, 45 ml; range 10–150 ml), 87 ml (median, 50 ml; range 15–150 ml) in the combined lung resection subgroup and 44 ml (median, 35 ml; range, 10–100 ml) in the laser only resection subgroup. Morphological analysis revealed the following results: a high level of tubercular activity was maintained in 12/39 (31%) resected tuberculous granulomas, a moderate level of tubercular activity was detected in 11/39 (28%) resected masses and remitting activity was identified in 16/39 (41%) resected masses. Along the laser resection line of the lung the edge of a tuberculous growth was found in 10/39 cases (26%). The average post-operative duration of pleural drainage was 3.9 days (median, 3 days; range, 2–9 days) in total, 4.1 days (median, 5 days; range, 2–6 days) in the combined subgroup and 3.8 days (median, 3 days; range, 2–9 days) in the laser-only subgroup. The number of post-operative complications assessed according to the Clavien-Dindo scale was two out of 32 patients (6.2%), with two cases of residual pleural cavities. Post operative mortality was 0%. Conclusion: Our first experience of using the Nd:YAG laser with a wavelength of 1318 nm for the resection of limited forms of tuberculosis demonstrated a high level of efficacy and excellent aero- and hemostatic properties with a low rate of post-operative complications even though the differences between the combined resection and laser-only subgroups were not statistically significant (p>0.05). However, the method is applicable in surgery of limited forms of lung tuberculosis in different variants, performing pure laser resections and as an additional method for other types of lung resections.

Light and lasers for vascular and skin diseases: From bench to clinic – An update

“…Assis et al [35] investigated the enhancement of muscle regeneration through modulation of inflammatory markers, accentuating possible applications of the low-level laser therapy which can induce physiological reactions when it interacts with cell membranes, cellular organelles and enzymes. In a case series of 32 patients, Bashenow et al [36] used a 1318-nm Nd:YAG laser for the resection of limited forms of pulmonary tuberculosis and stated a high level of efficacy and excellent aero-and hemostatic properties with a low rate of post-operative complications even though further studies in large groups of patients are needed. Last but by no means least, Gobbo et al [37] generated expressive results in the treatment of anal cancer patients who had to undergo different anticancer therapies, including radiotherapy, and were suffering from radiodermatitis.…”