ABSTRACT
Laser technology has provided us with new options for the endoscopic management of patients with selected diseases of the tracheobronchial tree. Polanyi et al. (1) reported the first endoscopic delivery system for carbon dioxide (CO2) laser surgery of the tracheobronchial tree in 1970. Three years later. Strong and his colleagues (2) successfully coupled this prototype endoscopic adapter to a standard, rigid, ventilating bronchoscope. Problems with this first adapter included its size and rather cumbersome arrangement for coupling to the bronchoscope; therefore, a smaller and lighter endoscopic adapter that coupled easily to the bronchoscope was developed in 1974. Strong et al. (3) presented their initial experiences with these two endoscopic adapters for bronchoscopic CO2 laser surgery at the 1974 Annual Meeting of the American Broncho-Esophagological Association. This report represented a logical extension of the clinical application of lasers in medicine and surgery. Specifically, use of the CO2 laser coupled to a rigid, ventilating bronchoscope allowed the surgeon to perform "hands-off" endoscopic surgery through the relatively long and narrow operative field of a ventilating bronchoscope. The advantages of precision, hemostasis, and decreased perioperative edema helped to facilitate visualization and control over the final result of the operation. However, lack of an aiming beam that would have allowed the surgeon to visualize the precise area of tissue to be vaporized by the invisible CO2 laser limited the growth of bronchoscopic CO2 laser surgery with this device. Laforet et al. (4) in 1976, Healy et al. (5) in 1979, Kullman (6) in 1980, Andrews and Horowitz (7) in 1980, McElvein and Zorn (8,9) in 1981 and 1983, Simpson et al. (10) in 1982, and Shapshay et al (11,12) in 1983 reviewed their experience with this bronchoscopic laser system in the management of patients with benign and malignant diseases of <target id="page_210" target-type="page">210</target>Diagram of the bronchoscopic coupler (<italic>Source:</italic> reprinted with permission of <italic>Otolaryngology and Head and Neck Surgery,</italic> C. V. Mosby, Publisher). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003065753/38edd0d1-eefc-4496-a597-c2e09401e4fa/content/fig7_1.tif"/> the tracheobronchial tree. Limitations with this laser bronchoscope system promp ed research and development of a new endoscopic coupler for bronchoscopic CO2 laser surgery as well as investigation of a different wavelength for bronchoscopic laser surgery, the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.
