[A new handpiece attachment for Nd:YAG laser ablation of emphysematous bullae]

Recently, attention has been drawn to lung volume reduction for bullous emphysema by wedge excision or laser ablation. We used a neodymium: yttrium-aluminum garnet (Nd:YAG) laser with a free-beam mode to ablate peripheral emphysematous areas of lung tissue. To aid us in this procedure, we developed an attachment consisting of a stainless steel rod 3 cm in effective length, with a 1.8-cm diameter ring attached to its tip, and installed it on the tip of the laser handpiece used for free-beam laser ablation. This device has the following distinct advantages: 1) the distance between the tip of the laser and the pleura can easily be held constant, 2) the angle of irradiation can easily be maintained at 90 degrees. These result in 3) a constant area of irradiation (one square centimeter), and 4) an irradiated area that is clearly distinguished by the ring. In addition, the attachment is 5) simple and easy to construct. Three patients with bullous emphysema underwent unilateral laser ablation of the visceral pleura with the new device. All patients recovered completely. We found this rod-and-ring attachment to be useful for free-beam laser ablation.