Use of the carbon dioxide laser for tracheobronchial lesions in children.

IMPORTANCE: Obstructing tracheobronchial diseases in children can be treated by a variety of techniques. The nonfiberoptic delivery of the carbon dioxide laser coupled to a rigid bronchoscope has rarely been described for this purpose and has unique advantages over other treatment methods.

OBJECTIVES: To report the indications, safety, efficacy, and limitations of the carbon dioxide laser delivered through a rigid bronchoscope for tracheobronchial lesions in the pediatric population.

DESIGN: Case series of patients undergoing treatment for tracheobronchial lesions at a single institution from December 2, 2001, through December 14, 2011.

SETTING: Tertiary care children's hospital.

PARTICIPANTS: Seventeen patients aged 3 months to 17 years with endotracheal and endobronchial disease.

INTERVENTION: Carbon dioxide laser treatment through a rigid bronchoscope.

MAIN OUTCOME MEASURES: Reduction in tumor burden or improvement of ventilation.

RESULTS: A total of 234 laser bronchoscopies were performed on 17 patients. Mean operative time was 29 (range, 2-89) minutes. Blood loss and complications were minimal. Sixteen patients received carbon dioxide laser delivered through a rigid bronchoscope with a proximal coupler or flexible fiber. The most common indication was tracheobronchial granulation tissue (n = 10), followed by prolapsed cartilage causing tracheal obstruction (n = 3), recurrent respiratory papillomatosis (n = 2), and granular cell tumor (n = 1). Of these patients, 15 (94%) underwent successful treatment. One patient was treated electively with the Nd:YAG laser owing to a vascular malformation.

CONCLUSIONS AND RELEVANCE: The carbon dioxide laser delivered through a rigid bronchoscope is a suitable tool for managing nonvascular endotracheal and endobronchial lesions in the pediatric population. Its unique wavelength properties offer a safe, effective alternative to other lasers and open resection.