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(Chest. 2001;120:934-940.)
© 2001 American College of Chest Physicians

Nd-YAG Laser Damage to Metal and Silicone Endobronchial Stents*

Delineation of Margins of Safety Using an In Vitro Experimental Model

Julius J. Dalupang, MD; Thomas G. Shanks, MPH and Henri G. Colt, MD, FCCP

* From Interventional Pulmonary Services, Pulmonary and Critical Care Medicine Division, University of California, San Diego Medical Center, San Diego, CA.

Correspondence to: Henri G. Colt, MD, FCCP, Director, Interventional Pulmonary Services, UCSD-La Jolla, 9310 Campus Point Dr, San Diego, CA 92037; e-mail: hcolt{at}ucsd.edu

Study objective: To identify margins of safety within which bronchoscopic Nd-YAG laser resection can be performed without damaging indwelling tracheobronchial stents.

Design: Experimental in vitro study simulating a patient-care environment.

Methods: Uncovered and covered metal Wallstent (Schneider; Zurich, Switzerland) and Dumon (Bryan Corporation; Woburn, MA) silicone stents were deployed in the tracheobronchial tree of a ventilated and oxygenated (fraction of inspired oxygen, 40%) heart-lung block of a dead canine. Rigid bronchoscopic Nd-YAG (1,064 nm) laser procedures were performed in order to deliver laser energy using fiber-to-target distances of 10 mm and 20 mm, and noncontact, continuous-mode, 1-s pulses at power settings of 10 W, 30 W, and 40 W. The major outcome measure was laser-induced stent damage, defined as discoloration, ignition, or breakage. This was assessed using six power densities: 75 W/cm2, 172 W/cm2, 225 W/cm2, 300 W/cm2, 518 W/cm2, and 690 W/cm2.

Results: The uncovered Wallstent and the silicone stent remained intact at power densities of 75 W/cm2 (10 W, 20 mm) and 172 W/cm2 (10 W, 10 mm), but were damaged at power densities > 225 W/cm2 (30 W, 20 mm). The covered Wallstent was damaged at all power densities tested.

Conclusion: Uncovered Wallstent and silicone stents are not damaged when Nd-YAG laser energy is delivered using power densities <= 172 W/cm2 (10 W, 10 mm). Covered Wallstents, however, had a high likelihood of ignition at all power densities studied.

Key Words: bronchoscopy • complications • laser physics • laser/tissue interactions • metal stents • Nd-YAG laser resection • power density • silicone stents




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