laser ber coolant airfow at the minimum level and avoiding direct contact between the laser probe and the airway tissue.

Summary and Recommendations

•\ Bronchoscopic laser resection has to be considered as a part of a more complete treatment called “Laser Assisted Mechanical Resection/ Dilation—LAMR/LAMD). It is rapid, effective, repeatable, and may be complementary to other therapies.

•\ Bronchoscopic LAMR/D is used to relieve malignant or benign intraluminal airway obstruction. It has no role when the obstruction is caused by sole extrinsic compression.

•\ In malignant stenosis LAMR consists of—rstly laser coagulation, then mechanical resection, nally low power laser treatment in depth of the implantation base.

•\ The type of laser that is most commonly used for LAMR is the neodymium-yttrium-­ aluminum-­garnet (Nd:YAG) laser. It relieves airway obstruction by either resecting or vaporizing the obstructing lesion.

•\ Bronchoscopic laser resection should only be performed by bronchoscopists who have advanced training and experience.

•\ Complications are infrequent but they include hemorrhage, airway wall perforation, airway wall necrosis, stula formation, and air embolism.

References

1.\Gorden JA, Ernst A. Endoscopic management of central airway obstruction. Semin Thorac Cardiovasc Surg. 2009;21(3):263–73.

2.\Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med. 2004;169:1278.

3.\Murgu SD, Egressy K, Laxmanan B, et al. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest. 2016;150(2):426–41.

4.\Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary proce-

dures: guidelines from the American College of Chest Physicians. Chest. 2003;123:1693.

5.\Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J. 2002;19:356.

6.\Stephens KE Jr, Wood DE. Bronchoscopic management of central airway obstruction. J Thorac Cardiovasc Surg. 2000;119:289.

7.\Seijo LM, Sterman DH. Interventional pulmonology. N Engl J Med. 2001;344:740.

8.\Minna JD, Higgins GA, Glaistein EJ. Cancer of the lung. In: De Vita VT, Hellman S, Rosemberg SA, editors. Cancer principles and practice of oncology. Philadelphia: JB Lippincott; 1989. p. 591–705.

9.\Chetty KG, Moran EM, Sassoon CSF, et al. Effect of radiation therapy on bronchial obstruction due to bronchogenic carcinoma. Chest. 1989;95:582–4.

10.\Hazuca MB, Bunn PA. Controversies in the treatment of stage III non small cell cancer (state of the art). Am Rev Respir Dis. 1992;145:967–77.

11.\Cavaliere S, Bezzi M, Toninelli C. Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi Arch Chest Dis. 2007 Jun;67(2):73–80.

12.\Williamson JP, Phillips MJ, Hillman DR, Eastwood PR. Managing obstruction of the central airways. Intern Med J. 2010;40(6):399–410.

13.\Duhamel DR, Harrell JH 2nd. Laser bronchoscopy. Chest Surg Clin N Am. 2001;11:769.

14.\Ramser ER, Beamis JF Jr. Laser bronchoscopy. Clin Chest Med. 1995;16:415.

15.\Zollner F. Gustav Killian: father of bronchoscopy. Arch Otolaryngol. 1965;82:656–9.

16.\Jackson C. The life of chevalier Jackson—an autobiography, vol. 106. New York: Macmillan; 1938.

17.\Marasso A, Gallo E, Massaglia GM, et al. Cryosurgery in bronchoscopic treatment of tracheobronchial stenosis. Indications, limits, personal experience. Chest. 1993;103:472–4.

18.\Dumon JF, Reboud E, Garbe L, et al. Treatment of tracheobronchial lesions by laser photoresection. Chest. 1982;81:278–84.

19.\Kvale PA, Selecky PA, Prakash UB, American College of Chest Physicians. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:368S.

20.\Wahidi MM, Herth FJ, Ernst A. State of the art: interventional pulmonology. Chest. 2007;131:261.

21.\Daddi G, Puma F, Avenia N, et al. Resection with curative intent after endoscopic treatment of airway obstruction. Ann Thorac Surg. 1998;65:203.

22.\Mehta AC, Golish JA, Ahmad M, et al. Palliative treatment of malignant airway obstruction by Nd-YAG laser. Cleve Clin Q. 1985;52:513.

23.\Carlin BW, Harrell JH, Olsen LK, Moser KM. Endobronchial metastases due to colorectal carcinoma. Chest. 1989;96:1110.

24.\Cavaliere S, Venuta F, Foccoli P, et al. Endoscopic treatment of malignant airway obstruction in 2,008 patients. Chest. 1996;110:1536–42.

25.\Bolliger CT. Combined treatment modalities in lung cancer. In: Rigid bronchoscopy meeting, Marselle; 1994. p. 177–87.

26.\Vergnon JM. Which treatment for inoperable obstructive lung cancer?. In: Transatlantic interventional pulmonology course. Marseille; 1996. p. 109–21.

27.\Casalini A, Cavaliere S, Consigli GF, et al. Standard operativi e linee guida in endoscopia toracica. Rass Pat App Resp. 1997;12:314–29.

28.\Cavaliere S, Beamis J. Endoscopic views-laser. In: Cavaliere S, Beamis J, editors. Atlas of therapeutic bronchoscopy, laser–stents. Brescia: RIBeL; 1991. p. 45.

29.\Sutedja TG, Schreurs AJ, Vanderschueren RG, et al. Bronchoscopic therapy in patients with intraluminal typical bronchial carcinoid. Chest. 1995;107:556–8.

30.\Puma F, Carloni A, Casucci G, et al. Successful endoscopic Nd-YAG laser treatment of endobronchial endometriosis. Chest. 2003;124:1168.

31.\Grillo HC, Donahue DM. Post intubation tracheal stenosis. Semin Thorac Cardiovasc Surg. 1996;8:370–80.

32.\Foccoli P, Scappaticci E, Rea F. Monaldi Arch Chest Dis. 2011;75(1):82–5. Management of post-­intubation and/or tracheotomy tracheal stenoses.

33.\Strausz J. Management of postintubation tracheal stenosis with stent implantation. J Bronchol Interv. 1997;4:294–6.

34.\Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest. 2001;119:781.

35.\Natalini G, Cavaliere S, Seramondi V, Foccoli P, Vitacca M, Ambrosino N, Candiani A. Negative pressure ventilation vs external high-frequency oscillation during rigid bronchoscopy. A controlled randomized trial. Chest. 2000;118(1):18–23.

36.\Dumon JF, Cavaliere S. Manuale di laserterapia endotracheobronchiale. Edizioni Clas International s.r.l.

37.\Shapshay SM, et al. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilatation. Ann Otol Rhinol Laryngol. 1987;96:661–4.

38.\Metha AC, Fyw L, Cordasco EM, Eliachar I, De Boer G. Concentric tracheal and subglottic stenosis: management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation. Chest. 1993;104:673–7.

39.\Baugnee PE, Marquette CH, Ramon P, et al. Endoscopic treatment of post-intubation tracheal stenosis. A review of 58 cases. Rev Mal Respir. 1995;12:585–92.

40.\Perrone R. Treatment of post intubation stenosis with neodymium-YAG contact laser by fexible endoscopy and topical anesthesia: instrumentation and results. J Bronchol Interv. 1996;3:252.

41.\Dumon JF. Technique of safe laser surgery. Lasers Med Sci. 1990;5:171.

42.\Scherer TA. Nd-YAG laser ignition of silicone endobronchial stents. Chest. 2000;117:1449.

43.\Ossoff RH, Duncavage JA, Eisenman TS, Karlan MS. Comparison of tracheal damage from laser-­ ignited endotracheal tube res. Ann Otol Rhinol Laryngol. 1983;92:333.

44.\Personne C, Colchen A, Bonnette P, et al. Laser in bronchology: methods of application. Lung. 1990;168(Suppl):1085.

45.\Uğur Chousein EG, Turan D, Özgül MA, Çetinkaya E. Secondary pulmonary malignancies requiring interventional bronchoscopic procedures. Turk Gogus Kalp Damar Cerrahisi Derg. 2021;29(3):360–9. https://doi.org/10.5606/tgkdc.dergisi.2021.19927.

46.\Cavaliere F, Dumon JF. Laser bronchoscopy. In: Bollinger CT, Mathur PN, editors. Interventional bronchoscopy. Basel: Karger AG; 2000. p. 108.

47.\Cavaliere S, Foccoli P, Farina PL, Nd:YAG laser bronchoscopy. A ve-year experience with 1,396 applications in 1,000 patients. Chest. 1988;94(1):15–21.

48.\Tellides G, Ugurlu BS, Kim RW, Hammond GL. Pathogenesis of systemic air embolism during bronchoscopic Nd:YAG laser operations. Ann Thorac Surg. 1998;65:930.