What is laser resection?
Using an Nd:YAG laser at the 1064 nm wavelength as a cutting and coagulating device has been utilized throughout the world for many years in certain surgical procedures. However, repeated attempts for its use on lung tissue had proven unfavorable due to the lungs high water content and propensity for air leaks. After many unsuccessful years attempting to discover a wavelength useful on lung tissue, it was decided in the mid 1980's by the US government to no longer fund this research. Europe however, continued on. It was in 1988 that Rolle and colleages published the first findings of a laser wavelength having both superb cutting and coagulation qualities; the 1318 wavelength was discovered. It was not only the wavelength that made this laser special, but it was the addition of a heat dispersing hand piece that Dr. Rolle had designed allowing him controlled precision resection with a consistant margin of high heat coagulation and tissue sealing thus preventing airleak. With this technology, Dr. Rolle was able to resect multiple metastatic tumors as well as centrally located tumors while both sparing healthy lung tissue and reducing the lobectomy rate. After eight years of animal studies is was evident that this laser was ready for use on human lungs. So in 1996 Dr. Rolle began using the Nd:YAG 1318 laser for lung metastasectomy at the Specialized Hospital for Thoracic and Vascular Surgeries (Fachkrankenhaus Coswig) Germany.
Laser resection of multiple mets requires full access to the lung via an open thoracotomy. To begin the surgery, an incision is made from the axilla (armpit) to just under the breast. The muscles are parted in a unique muscle sparing procedure performed by Rolle. The ribs are then spread and the operated lung deflated by anesthesiology. Every nodule is palpated manually and the laser is used to burn around the tumor with a clean margin and is removed thus saving surrounding healthy tissue. A small suture is applied to each lasered site for reinforcement while healing. This continues for each met palpated.
Dr. Rolle has removed tumors as large as 8 cm and as many as 265 bilateral mets in a single patient (all 1mm-1.5cm). The lobectomy rate at Fachkrankenhaus is 2/3 less than in the states. Candidacy and number of resectable mets are at the discretion of Dr. Rolle after a thorough review of the patient's cat scan.
So for those having multiple mets and deemed inoperable or those desiring to save healthy lung tissue during metastasectomy, you have an option in Germany. This technology is not yet available in the United States, and will be some time before our government and medical professionsals realize the opportunity this technology provides for multiple metastasectomy. Please share the publications on this technology with your doctors as the decision to pursue this procedure requires a medical professionals input having all options thoroughly discussed. Be aware that US surgeons are not familiar with this technology and are prhibited from suggesting treatment outside of the US.
