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Impacted broncholiths removed with the holmium: YAG laser
J S McCaughan1, H G Heinzmann, D McMahon
1Grant Laser Center and Laser Medical Research Foundation, Columbus, Ohio, USA.
Background And Objective:
Although the Nd: YAG laser has been used endoscopically to remove broncholiths, our experience with it for this purpose has been tedious and difficult. The calculus burns and partially vaporizes, but most of the removal has to be done mechanically with crushing from biopsy forceps. Laser lithotripsy for ureteral calculi has been reported using the pulsed Holmium:YAG laser to fragment the calculus, and we evaluated the efficacy of this laser to remove impacted broncholiths.
Study Design/Materials And Methods:
Two patients with impacted broncholiths obstructing segments of the right middle lobe were treated using a pulsed Holmium:YAG laser. General endotracheal anesthesia with an FIO2 of 40% was used, and the laser energy was delivered through a 365-microns bare tip fiber passed through the biopsy channel of a flexible bronchoscope inserted through the endotracheal tube.
Results:
The calculi were easily fragmented and removed with suction.
Conclusion:
The pulsed Holmium:YAG laser was an effective tool to fragment and remove impacted broncholiths with minimal side effects using 2 J and 5 Hertz. The calculi exploded into tiny fragments.
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