Palliative treatment of malignant airway obstruction by Nd-YAG laser1

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Photoresection using the neodymium-yttrium aluminum garnet (Nd-YAG) laser is an accepted modality for the treatment of unresectable symptomatic endobronchial lesions. The safety and efficacy of this technique when performed through a rigid bronchoscope have already been established. Forty-two such photoresection procedures were performed through a flexible fiberoptic bronchoscope at the Cleveland Clinic Foundation. The preoperative workup included sector computed tomography (CT) scanning of the mediastinum and/or magnetic resonance (MR) imaging of the chest. The results indicate that Nd-YAG laser photoresection can be safely performed using the flexible bronchoscope. Anatomic information provided by MR and sector CT may add to the safety of this procedure by allowing avoidance of major vessel perforation.