[Application of the Nd-YAG laser for surgical resection of pulmonary metastases].

We used Nd-YAG laser equipment for operations on pulmonary metastatic tumors in order to preserve the residual pulmonary functions simultaneously with local curability by utilizing the features of the contact and non-contact types of equipment. The subjects were patients showing no lymph node metastasis in the preoperative diagnosis. The equipment used was Nd-YAG laser model 6,000 with a surgical probe and contact tip attached. Thoracotomy was performed by a method involving minimum invasion in accordance with the tumor localization to prevent reduction of the postoperative respiratory function as much as possible. An incision was made in the pleura and lung using the contact tip with an output of about 25 Watts with the surgical margin separated sufficiently from the tumor, and the tumor was resected. Coagulative hemostasis was apt to occur in the small vessels. To eliminate postoperative hemostasis and residual tumors, non-contact type irradiation was performed at the surgical margin at an output of about 50-70 Watts. Finally, the pleura were sutured. This method has been used so far on 10 cases of pulmonary metastatic tumors, and in all cases, the amount of hemorrhaging during the operation was small, the operating time was short and the postoperative reduction in respiratory function was slight. In cases of bilateral multiple pulmonary metastases, as many as 30 resections were performed, but no recurrences have been seen in any of the cases to date. Although the usefulness of this method still cannot be confirmed because of the small number of cases involved, this method seems promising from the standpoints of local curability and preservation of pulmonary functions.