Reopening the airway: Fast methods-laser-assisted mechanical resection, electrocautery, and argon plasma coagulation

Abstract

Interventional options for central airway obstruction are subject to the availability of experienced personnel and equipment. In addition, the degree of obstruction and severity of symptoms, the nature of the underlying problem, and the patient's overall prognosis and quality of life impact the choice of intervention. No controlled trials have been published that compare the various modalities that can be applied to open an obstructive airway. As a result, current practice is based upon local influences, available resources and equipment, the bronchoscopist's training and preferences, and uncontrolled studies. Of all options, only bronchoscopic laser resection, argon plasma coagulation (APC), and electrocautery produce rapid tissue destruction in a single session and are therefore appropriate to treat lesions that are producing acute respiratory distress or hemoptysis. Bronchoscopic laser resection has to be considered as a part of a more complete treatment called laser-assisted mechanical resection/dilation-LAMR/LAMD. Bronchoscopic LAMR/LAMD is used to relieve malignant or benign intraluminal airway obstructions. It has no role when the obstruction is caused by sole extrinsic compression. It is rapid, effective, and repeatable and may be complementary to other therapies. Endobronchial electrocautery and APC are frequently seen as less expensive alternatives to laser therapy with similar effects and as such similar indications. These treatment modalities are indicated for any benign or malignant tissue destruction responsive to heat delivery. These indications include endobronchial malignancy, benign tumors, relief of postintubation stenosis, and, in the case of APC, treatment of stent-induced granuloma.