Video-Assisted Laser Resection of Lung Metastases—Feasibility of a New Surgical Technique

Abstract

Our pilot study describes our initial experience to do a laser resection of lung metastases under video-assisted thoracoscopic control via a minithoracotomy. With this approach, if needed, mediastinal lymphadenectomy is also possible. In this study, 15 patients (11 men and 4 women, mean age: 60 years) with resectable lung metastases of different solid primary tumors (colorectal cancer in seven patients, melanoma in three patients, renal cell carcinoma in two patients, and one each with oropharyngeal cancer, breast cancer, and seminoma) were included. An anterior minithoracotomy incision (approximately 5-7 cm length) was created in the fifth intercostal space and a soft tissue retractor (Alexis Protector; Applied Medical) was positioned. Two additional working ports were inserted. The entire lung was palpated via the minithoracotomy. All detected lung metastases were removed under thoracoscopic control. Nonanatomic resections were performed using a diode-pumped neodymium-doped yttrium aluminium garnet laser (LIMAX120; KLS Martin GmbH& Co KG) with a laser power of 80 W in a noncontact modus. Deeper parenchymal lesions were sutured. A total of 29 lung metastases up to 30 mm in size were resected and all metastases diagnosed on preoperative imaging were detected. All diagnosed lung metastases were completely resected (R0). The median operation time was 102 (range: 85-120) minutes. Median blood loss was 47.6 mL and no postoperative complications occurred. Neither local recurrences nor new lung metastases were observed within 6 months after the procedures. Video-assisted laser resection of lung metastases is safe, effective, and fulfills the requirements of modern lung metastases surgery.

Video assisted laser resection of lung metastases: a new surgical technique

“…Even more centrally located lung metastases can be removed with precision, omitting the need for anatomical resection. Video-assisted resection via mini-thoracotomy using a focusing handpiece of the kind employed in open surgery is feasible, as we were able to demonstrate in a small study (17). For this less invasive application however, these commercially available handpieces are frequently too short and correct alignment with the lung parenchyma inside the thoracic cavity may be difficult.…”

Pulmonary laser-assisted metastasectomy is associated with prolonged survival in patients with colorectal cancer

“…Equal survival could previously be shown after VATS surgery compared to thoracotomy in several cases ( 12), yet extent and technique of surgery required for detecting all nodules remain avidly discussed (12)(13)(14)(15)(16). A combined approach using a minithoracotomy that allows thorough palpation of the lung and performing the resections under video-assisted thoracoscopic control has also been proposed (17). However randomized controlled trials are still lacking.…”

Local Effects of a 1940 nm Thulium-Doped Fiber Laser and a 1470 nm Diode Laser on the Pulmonary Parenchyma: An Experimental Study in a Pig Model

“…Lasers can be used to excise more metastases while achieving an equivalent long-term survival rate and enabling re-operations when necessary [ 18 ]. Some previous studies have even demonstrated the superiority of laser ablation compared with standard surgical procedures in terms of the success of radical resection, patient survival rates, the simplicity of video-guided laser procedures during minithoracotomy, and the possibility of intra-operative lung palpation [ 19 , 20 ]. In summary, laser use in lung surgery is highly promising due to the fact of its prevention of hemorrhaging during and post-surgery, its preservation of healthy lung tissue as well as the possibility it provides of removing cavernous lesions in sites that were previously inaccessible surgically [ 21 ].…”