Usefulness of the Nd:YAG laser in parenchyma-sparing resection of pulmonary nodular lesions

AIMS AND BACKGROUND: The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser has been successfully employed in parenchyma-sparing resection of pulmonary nodular lesions. We report our experience with limited resection using a noncontact Nd:YAG laser applied through a thoracotomic approach. METHODS: During the period March 1987-October 1993, we performed parenchyma-sparing resections of 66 pulmonary nodular lesions with a noncontact Nd:YAG laser in 47 patients. Nodules were approached through postero-lateral thoracotomy (n = 40), median sternotomy (n = 5) or staged bilateral thoracotomy (n = 2). Fifty-two lesions were located in a peripheral position and the others (n = 14) at various depths within the parenchyma. RESULTS: Fifteen lesions were benign: hamartoma (n = 5), chronic pneumonic infiltrate (n = 3), tuberculoma (n = 3), asbestosis (n = 2), Wegener's granuloma (n = 1). Twelve lesions were attributable to primary lung cancer and 33 were metastatic lesions. Another 6 lesions turned out to be necrotic metastases following chemotherapy. There were no perioperative deaths. Pulmonary re-expansion was shortly obtained: mean drainage time was 4.31 +/- 3.9 days. Only one patient presented a prolonged drainage time (11 days); in this case, the air leak was successfully treated by tissue glue sealant trans-drainage infiltration. Follow-up ranged from 2 to 96 months. No case of relapse on the resection site has been observed. CONCLUSIONS: The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.