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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.
The Laryngoscope
|July 17, 2025
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).
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.
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