- Henri G Colt, MD
Henri G Colt, MD
- Professor of Medicine
- University of California Irvine
Tracheobronchial obstruction due to malignant or benign processes can produce recurrent pneumonia, respiratory insufficiency, and death. Curative resection is not possible in the majority of cases, and treatment instead is focused upon palliation. Several techniques are available for the bronchoscopic treatment of obstructing tissue in the tracheobronchial tree, including electrocautery, laser therapy, cryosurgery, airway stents, brachytherapy, and balloon dilation [1,2]. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults".)
Of these options, only laser resection and electrocautery produce rapid tissue destruction in a single sitting, and are therefore appropriate to treat lesions that are producing acute respiratory distress or hemoptysis. The neodymium yttrium aluminum garnet (Nd:YAG) laser generally is used in this situation in the United States, but expense limits the availability of laser equipment in many parts of the world. Electrocautery could be called "the poor man's laser" because it also produces rapid thermal destruction of tissue, but does so relatively inexpensively by means of electric current rather than laser light [3,4]. (See "Basic principles of medical lasers" and "Bronchoscopic laser in the management of airway disease in adults".)
The technique of endobronchial electrocautery, also referred to as electrofulguration, diathermy, electrocoagulation, thermocoagulation, or electrosurgery, will be reviewed here. Other therapeutic bronchoscopy techniques are discussed separately.
Electrocautery was first used in the 1930s to treat rectal cancer . Endoscopic electrocautery subsequently has found wide use in the treatment of gastrointestinal lesions, such as colonic polyps, bleeding vessels, and biliary stenosis.
Initial reports of the potential utility of electrocautery in the treatment of tracheal and bronchial tumors also appeared in the 1930s [6-8], but complications such as burns, tracheal perforation, and fatal hemoptysis dampened enthusiasm for the technique . Refinements of the electrodes and other hardware and the use of more sophisticated generators of high frequency current have improved the efficacy and safety of bronchoscopic electrocautery and have led to a renewed interest in the technique. Nonetheless, the literature describing palliative electroresection is limited, and most pulmonologists remain unfamiliar with its use.
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- HISTORICAL BACKGROUND
- BASIC PRINCIPLES OF ELECTROCAUTERY
- - Soft coagulation
- - Forced coagulation
- - Spray coagulation
- Tissue effects of electrocautery
- INDICATIONS AND EFFICACY
- Malignant tumors
- Benign lesions
- Electrocautery electrodes
- High frequency current generator
- Postoperative care
- SUMMARY AND RECOMMENDATIONS