Initial report of neodymium: Yttrium-aluminum-perovskite (Nd:YAP) laser use during bronchoscopy

Background: Neodymium:yttrium-aluminum-garnet laser used during bronchoscopy has been effective in treating airway obstruction. Other lasers with different properties have not been well described during bronchoscopy. The neodymium:yttrium-aluminum-perovskite (Nd:YAP) laser has different characteristics than the Neodymium: yttrium aluminum garnet laser. Methods: A single center retrospective review was conducted to assess safety and efficacy of the Nd:YAP laser during bronchoscopy. The review encompassed all bronchoscopies using the Nd:YAP laser. The data included the indication (photocoagulation before debulk-ment or stenting, vaporization of tumor or granulation tissue, stenosis, hemoptysis), laser power settings, airway location, method of delivery (flexible or rigid bronchoscopy), complications (bleeding, death, hy-poxia), and outcome of the procedure (successful debulkment and recanalization, stent placement, resolution of bleeding, release of stenosis). Results: Forty-four patients underwent bronchoscopy using the Nd:YAP laser (24 rigid bronchoscopy, 7 flexible bronchoscopy, 5 flexible through a rigid bronchoscope). All patients with an obstructed airway were recanalized. All 18 patients that had mechanical core out of tumor with a rigid bronchoscope with previous photocoagulations were successful. Airway stent deployment was successful after pretreatment with the laser in all but one case (24 of 25 patients). Two patients with attempted tumor vaporization required additional debulking methods. All 4 cases of tracheal stenosis required additional cutting methods for stenosis release. Two patients with hemoptysis resolved their bleeding after treatment. One of 2 patients with granulation tissue was treated successfully with laser alone. There was no mortality or complication directly related to laser application. Conclusions: The Nd:YAP laser is a safe and effective tool for bronchoscopy.