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Redefining Safe Practices in Airway TruBlue Laser Surgery-A Systematic Evaluation.

Ariel Roitman1,2, Marcus Wilson3, Andrew J Bowen1

  • 1Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.

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|July 17, 2025
PubMed
Summary

The TruBlue laser is safe for airway surgery when used with a laser-safe endotracheal tube (LSETT) and without extrinsic fuel. Fires only occurred with pledgets under high-flow ventilation (HFV).

Keywords:
FiO2 limitTruBlue laserairway surgeryexperimental studyfire riskmicrolaryngoscopyporcine laryngeal model

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Area of Science:

  • Otolaryngology
  • Surgical Technology
  • Laser Safety

Background:

  • Fire risk is a known complication during laser airway surgery.
  • Limited data exists on the safety of the novel TruBlue laser in this context.

Purpose of the Study:

  • To evaluate the fire risk associated with the TruBlue laser under various experimental conditions.
  • To assess the safety of the TruBlue laser in conjunction with different ventilation methods and oxygen concentrations.

Main Methods:

  • Trials were conducted on a cadaveric porcine larynx and lungs model.
  • Tested laser-safe endotracheal tubes (LSETTs), high-flow ventilation (HFV), and jet ventilation.
  • Varied distance, FiO2 levels, and laser power settings to monitor fire events.

Main Results:

  • No fire events occurred with LSETTs.
  • Uncontrolled fires (pledget fires) were observed only with HFV at varying FiO2 levels.
  • Brief flames and increased spark ignition rates were noted with higher laser wattage and specific ventilation methods.

Conclusions:

  • The TruBlue laser is safe when used with a fully inflated LSETT cuff and positioned appropriately, even with 100% oxygen.
  • Extrinsic fuel sources, such as pledgets, represent the primary fire risk.
  • HFV and jet ventilation showed increased sparks and brief flames compared to LSETT use, but were safe in the absence of extrinsic fuel.