Pulmonary procedures assisted by optosurgical and electrosurgical devices: comparison of damage potential

Electrosurgical devices have been used widely in thoracic surgery to assist in dissection and to reduce hemorrhage. Recent experimental data have shown that lasers may be used to resect and control small air leaks while conserving normally functioning lung. This investigation quantitates the amount of damage produced by the electrosurgical unit (ESU), the carbon dioxide laser (CO2), and the neodymium: YAG laser (YAG) compared to standard suture (SU) techniques. Six dogs were anesthetized, intubated, and ventilated. The left chest was opened and the lower lobe exposed, where four sets of lesions were created using each device. All lesions were visually similar to those lesions that would be created for sealing at the time of a pulmonary resection. The lesions were harvested immediately following wounding as well as at 1, 3, and 6 week intervals. They were examined histologically and ranked from least to most damage produced at each interval. A grading system (0-4+) was also devised to compare the injury to simultaneously harvested normal lung. Immediately following injury, histologic ranking was: CO2 (2+), suture (2+), ESU (3+), YAG (4+). By 6 weeks, the suture damage had become minimal and the ranking was: suture (1+), CO2 (2+), YAG (4+), ESU (4+). The ESU consistently produced more extensive damage than any other device. It appears that the most suitable long-term adjunctive devices to assist in pulmonary surgery are suture and the CO2 laser. The YAG laser may have specific indications in circumstances when significant blood loss may be encountered. ESU usage should be minimized when attempting to preserve functioning lung tissue.