- 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19:356.
- Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123:1693.
- Boxem Tv, Muller M, Venmans B, et al. Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest 1999; 116:1108.
- Coulter TD, Mehta AC. The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection. Chest 2000; 118:516.
- Strauss AA, Strauss SF, Crawford RA. Surgical diathermy of carcinoma of the rectum. Its clinical end results. JAMA 1935; 104:1480.
- Gilfoy, FE. Primary malignant tumors of the lower third of the trachea: Report of a case with successful treatment by electrofulguration and deep x-rays. Arch Otolaryngol 1932; 16:182.
- Kernan, JD. Carcinoma of the lung and bronchus: Treatment with radon implantations and diathermy. Arch Otolaryngol 1933; 17:457.
- Moersch HJ, Bowing HH. PRIMARY CARCINOMA OF THE BRONCHUS TREATED SUCCESSFULLY WITH SURGICAL DIATHERMY. Ann Surg 1935; 102:989.
- Soulas A, Mounier-Kuhn P. Bronchologie, Masson Ed, Paris 1956. p.703-704.
- Barlow DE. Endoscopic applications of electrosurgery: a review of basic principles. Gastrointest Endosc 1982; 28:73.
- Davison JM, Zamah NM. Electrosurgery: principles, biologic effects and results in female reproductive surgery. Glob libr women’s med. ISSN 1756-2228;DOI 10.3843/GLOWM.10021. http://www.glowm.com/section_view/heading/Electrosurgery:%20Principles,%20Biologic%20Effects%20and%20Results%20in%20Female%20Reproductive%20Surgery/item/21 (Accessed on May 28, 2015).
- Sagawa M, Sato M, Takahashi H, et al. Electrosurgery with a fiberoptic bronchoscope and a snare for endotracheal/endobronchial tumors. J Thorac Cardiovasc Surg 1998; 116:177.
- Sutedja G, Schramel FM, Smit HJ, Postmus PE. A prospective study of bronchoscopic electrocautery (BE) in patients with intra luminal typical bronchial carcinoid (ITBC). Eur Respir J 1996; 23:258S.
- Frizzelli R. [Treatment by electrocoagulation in malignant tracheobronchial pathology]. Rev Pneumol Clin 1986; 42:235.
- van Boxem TJ, Venmans BJ, Schramel FM, et al. Radiographically occult lung cancer treated with fibreoptic bronchoscopic electrocautery: a pilot study of a simple and inexpensive technique. Eur Respir J 1998; 11:169.
- Sutedja G, van Kralingen K, Schramel FM, Postmus PE. Fibreoptic bronchoscopic electrosurgery under local anaesthesia for rapid palliation in patients with central airway malignancies: a preliminary report. Thorax 1994; 49:1243.
- Pedersen U, Kristensen S, Illum P. Palliative resection with high-frequency cutting loop in malignant tracheobronchial diseases. J Bronchol 1994; 1:23.
- Baldeyrou P, Girard P, Grunenwald D. High-frequency thermocoagulation of tumors of the respiratory tract: Results of an initial study with broncho fiberscope. J Bronchol 1996; 3:243.
- Sutedja G, Schramel FM, Smit HJ, Postmus PE. Bronchoscopic electrocautery as an alternative for ND-YAG laser in patients with intraluminal tumor (abstract). Eur Respir J 1996; 23:259S.
- Wahidi MM, Herth FJ, Ernst A. State of the art: interventional pulmonology. Chest 2007; 131:261.
- Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study. Lung Cancer 2003; 39:49.
- Dalupang JJ, Shanks TG, Colt HG. Nd-YAG laser damage to metal and silicone endobronchial stents: delineation of margins of safety using an in vitro experimental model. Chest 2001; 120:934.
- Colt HG, Crawford SW. In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents. Respirology 2006; 11:643.
- Ell C, Fleig WE, Hochberger J. Broken biliary metal stent after repeated electrocoagulation for tumor ingrowth. Gastrointest Endosc 1992; 38:197.
- Caramella JP, Dodinot B. [Cardiac pacemaker deprogramming by electrocautery. An update]. Ann Fr Anesth Reanim 1989; 8:290.
- Wahidi MM, Unroe MA, Adlakha N, et al. The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction. J Thorac Oncol 2011; 6:1516.
- Homasson JP, Roden S, Angebault M, et al. [Treatment of bronchial tumors with high-frequency thermocoagulation. Preliminary studies]. Rev Pneumol Clin 1995; 51:77.
- Petrou M, Kaplan D, Goldstraw P. Bronchoscopic diathermy resection and stent insertion: a cost effective treatment for tracheobronchial obstruction. Thorax 1993; 48:1156.
- Ledingham SJ, Goldstraw P. Diathermy resection and radioactive gold grains for palliation of obstruction due to recurrence of bronchial carcinoma after external irradiation. Thorax 1989; 44:48.
- Hooper RG, Jackson FN. Endobronchial electrocautery. Chest 1985; 87:712.
- Gerasin VA, Shafirovsky BB. Endobronchial electrosurgery. Chest 1988; 93:270.
- Marsh BR. Bipolar cautery for the fiberoptic bronchoscope. Ann Otol Rhinol Laryngol 1987; 96:120.
- Hooper RG, Jackson FN. Endobronchial electrocautery. Chest 1988; 94:595.
- Cunningham L, Wendell G, Berkowitz L, et al. Treatment of tracheobronchial granular cell myoblastomas with endoscopic bipolar cautery. Chest 1989; 96:427.
- Wakabayashi A. Thoracoscopic techniques. In: Minimally Invasive Techniques in Thoracic Medicine and Surgery, Hetzel MR (Ed), Chapman & Hall, London 1995. p.269.
- Hooper RG, Spratling L, Beechler C, Schaffner S. Endobronchial electrocautery. A role in bronchogenic carcinoma? Endoscopy 1984; 16:67.
- Carpenter RJ 3rd, Neel HB 3rd, Sanderson DR. Comparison of endoscopic cryosurgery and electrocoagulation of bronchi. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 1977; 84:313.
- Verkindre C, Brichet A, Maurage CA, et al. Morphological changes induced by extensive endobronchial electrocautery. Eur Respir J 1999; 14:796.
- Kvale PA, Selecky PA, Prakash UB, American College of Chest Physicians. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:368S.
- 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