Haemostasis after partial hepatectomy using argon beam coagulation

The argon beam coagulator is a new device for haemostasis during and after surgery on parenchymatous organs. No data are available on its efficacy and tissue effect following hepatic resection. Blood loss, the time needed to achieve adequate haemostasis and histological findings after liver resection were assessed in 12 pigs using argon beam coagulation or suture ligation only, the mattress suture technique and tissue glue application. The treatment was randomly assigned to each of the four liver lobes in each pig. Median blood loss following argon beam coagulation was 13 (range 2-47) ml and after simple suture ligation 55 (range 2-260) ml (P < 0.02). The median time needed for adequate haemostasis following argon beam coagulation was 3 (range 2-7) min versus 14 (range 2-48) min in the control group (P < 0.005). There was no difference between argon beam coagulation and tissue glue, which were both superior to the use of mattress sutures. Argon beam coagulation resulted in less tissue damage than tissue glue or mattress suturing. The argon beam coagulator is an efficient device for achieving haemostasis following partial hepatectomy in the pig. It causes only a moderate tissue reaction.     

Thyroidectomy without drainage

Recent randomized series did not support routine prophylactic drainage after thyroidectomy. We undertook a prospective study in order to evaluate the effectiveness and the morbidity of a non drainage strategy after thyroidectomy. Between april 1993 and may 1995, one hundred fifty consecutive patients underwent thyroidectomy without drainage. During this period, two thyroid cancers were treated by total thyroidectomy with a modified radical neck dissection and drainage; they are not included in the study. Age range was 16 to 72 years. Sex ratio was 126F/124M. Indication for surgery was: solitary nodule (16), multinodular goiter (56), Graves' disease (21), toxic nodular goiter (34), cancer (8), retrosternal goiter (13), thyroiditis (2). The surgery done was: total lobectomy + isthmusectomy (15), total lobectomy + subtotal controlateral thyroidectomy (42), bilateral subtotal thyroidectomy (84), total thyroidectomy (9). Surgical technique was identical to that used previously by the author when drainage was installed routinely. Patients left the hospital on the first or second postoperative day and were reexamined on day 7 and day 30. There was no mortality, no suffocating hematoma, no reoperation and no laryngeal nerve paralysis. One patient developed a transient hypocalcemia that regressed one month later. Two patients developed a minor hematoma of which one disappeared after two weeks and the other drained spontaneously through the surgical incision on the seventh postoperative day. We conclude that drainage after thyroidectomy has no adverse effects and can be avoided if meticulous surgery is done. Absence of drainage simplifies the early postoperative course, improves the comfort of the patient, decreases hospital stay and reduces hospital cost. However, drainage may be of value in case of hemostatic problems or associated cervical neck dissection.     

Circadian entrainment and phase shifting in mammals with melatonin

BACKGROUND: Diathermy procedures are indispensable in interventional endoscopy. Argon beam coagulation is an innovative no-touch electrocoagulation technique in which high-frequency alternating current is delivered to the tissue through ionized argon gas. METHOD AND PATIENTS: Before clinical application, we conducted in-vitro studies to investigate the depth and diameters of tissue coagulation in fresh operative specimens from the stomach, small intestine and colon. Five different power/gas flow settings between 40 and 155 W and 2 and 7 l/min were used. The impact time (1-10s) and the incident angle of the probe (45 degrees and 90 degrees) were also varied. The maximum depth of necrosis was 2.4 mm, the maximum diameter 1.1 cm. No perforation occurred even in critical areas such as the colon and duodenum. We therefore performed argon beam coagulation in 66 consecutive patients. Two power/gas flow settings of 40 and 70 W and 2 and 3 l/min, respectively, were used. The impact time and incident angle were varied individually. RESULTS: In 49 of the 50 patients with oozing haemorrhage from angiodysplastic lesions, polypectomy sites, erosions or ulcers or oozing of blood due to vascular penetration by tumours, definitive haemostasis was achieved in one to two sessions. In all 11 patients with residual sessile adenoma tissue, complete removal was possible. Oesophageal patency was restored in all five patients with stenosing tumours. In one patient with angiodysplasia of the caecal pole, an asymptomatic accumulation of gas in the submucosa was observed which resolved spontaneously. In two patients with extensive oesophageal carcinoma, there was a transitory--also asymptomatic--accumulation of gas in the mediastinum and peritoneal cavity but no evidence of perforation. CONCLUSION: Argon plasma electrocoagulation is an effective and relatively low-cost alternative to laser therapy in gastrointestinal endoscopy.     

Tissue adhesives and applications in plastic and reconstructive surgery

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.     

Effect of aspirin in coronary artery bypass grafting

OBJECTIVES: To evaluate the effect of aspirin (ASA) therapy on postoperative blood loss, transfusion requirements, reoperation for bleeding, duration of stay in the intensive care unit and in the hospital in a selected population undergoing a first coronary artery bypass grafting (CABG) surgery. DESIGN: Prospective observational study in consecutive patients during a 3-month period. SETTING: A teaching cardiothoracic center. PARTICIPANTS: Two hundred forty consecutive patients undergoing elective coronary artery bypass grafting surgery for the first time. INTERVENTIONS: Two hundred forty consecutive patients admitted for a first CABG the day before surgery were visited. patients with an abnormal routine coagulation screen or taking drugs that might have affected their coagulation mechanisms were prospectively excluded (n = 96). The date of the last dose of ASA was recorded in the 144 remaining patients, and data were acquired prospectively. MEASUREMENTS AND MAIN RESULTS: Total mediastinal blood drainage, blood products usage, reopening, and duration of intensive care unit and hospital stay were recorded. Patients were grouped by days free of ASA. There were no significant differences detected between groups. CONCLUSIONS: In patients undergoing a first CABG and with no known factors affecting their coagulation, ASA therapy did not appear to increase blood loss, reopening for bleeding, or blood products usage requirements during the hospital stay. ASA therapy did not influence the duration of stay in intensive care or in the hospital.     

Clipping of the thoracic duct with video-assisted thoracic surgery in the treatment of chylothorax after pulmonary resection

We describe a procedure for video-assisted thoracoscopic clipping of the thoracic duct to treat postoperative chylothorax. This technique was successfully performed on a 62-year-old man who developed chylothorax following right lower lobectomy and partial resection of the 11th and 12th vertebral bodies for squamous cell lung cancer. Because conservative therapy for 7 days failed to reduce the amount of pleural effusion, we performed thoracoscopic examination of the thoracic duct and found a site leaking chylous fluid. The thoracic duct was successfully and easily clipped resulting in complete elimination of the effusion in 2 days. Generally, chylothorax complicating pulmonary resection has been managed by medical treatment first, followed by surgical intervention in case that fail to respond to initial therapy. The newly designed video-assisted thoracic surgery procedure reduces the trauma, shortens the drainage period and hospital stay, and provides better exposure of the thoracic duct. We believe that this procedure can be carried out shortly after the occurrence of chylothorax.     

Sideroblastic refractory anemia and acute leukemia in Waldenstrom''s macroglobulinemia

Bartholin gland tumours are rare and therefore recommendations concerning management have been based on small series. Although there is a tendency today to perform less radical surgery, meaning hemivulvectomy or a wide local excision, the anatomical position of these tumours often leads to a large postoperative defect. The objective of this report is to present data on three patients but mainly to describe our surgical technique where a sliding flap obtained from the gluteal region is used for primary closure. This surgical procedure offers a functional and cosmetically acceptable vulva which is of importance considering the relative young age of patients with Bartholin gland tumours.     

Target volume and indications of radiotherapy in breast carcinoma

Breast-conserving surgery is now commonly used to treat breast cancer. While mastectomy has been the traditional treatment for ductal carcinoma in situ, it is felt to be excessive in most cases. A great effort has been made to identify pathobiological characteristics of DCIS that can be used to identify patients best suited for wide local excision vs. wide local excision and breast irradiation. Mastectomy and conservative surgery plus irradiation offer a similar outcome in patients with early stage invasive breast cancer. Radiotherapy has not been shown to improve survival but is able to reduce significantly the rate of local recurrence, which is regarded as a very undesirable outcome. There is still controversy concerning the necessity of irradiation of the breast in all patients. Analysis of predictors of outcome cannot identify a subgroup of patients with a very low risk for local breast recurrence who might not require radiation therapy. In premenopausal, node-positive breast cancer patients XRT has a beneficial effect not only on locoregional but also on systemic recurrences. Radiotherapy has to be integrated for a pre- or postoperative consolidation in new treatment concepts for locally advanced breast cancer which use primary chemotherapy and immediate or subsequent breast radiation. Radiation of internal mammary chain and supraclavicular fossa after conservative surgery does not lead to an increase in clinically important skin or pulmonary complications. Its role is being evaluated in current multicentre studies.     

The infected urachal cyst: primary excision versus a staged approach

PURPOSE: We compared outcomes following single or 2-stage repair of infected urachal cysts in the pediatric population. MATERIALS AND METHODS: We reviewed the records of 17 patients 1 day to 14 years old (median age 22 months) with a urachal cyst. Immediate cyst excision was performed in 6 patients without infection, while those with an abscess underwent single or 2-stage repair. RESULTS: Median postoperative hospital stay for the urachal abscess group was 14 and 11.5 days for single and 2-stage procedures, respectively. After immediate excision postoperative complications developed in each case, although none occurred with a 2-stage approach. CONCLUSIONS: In the absence of infection, urachal cyst excision affords the most benign postoperative course. However, when infection is present, perioperative drainage with subsequent total excision, including a cuff of bladder, may offer the most effective surgical option.     

Laparoscopic adrenalectomy

Between June and September 1993, laparoscopic adrenalectomy was indicated in five patients (three women, two men; aged 25-50 years). Three had a phaeochromocytoma, two had an adenoma (Conn's syndrome). Four of the five tumours were localized to the right adrenal gland, one to the left. Tumour diameter ranged from 3 to 5 cm. The laparoscopic procedure was successful in four of the patients (three right, one left). In the fifth case the operations had to be completed by conventional surgery, because of non-controllable haemorrhage. Duration of operation ranged between 165 and 360 min for right adrenalectomy and was 135 min for the left one. Rapid convalescence, lower dose of pain-killing drug required, short hospital stay and good cosmetic results characterized the postoperative course after the laparoscopic procedure. This technique thus opens up new perspectives for adrenal surgery.     

Reconstitution of squamous epithelium in Barrett's oesophagus with endoscopic argon plasma coagulation: a prospective study

BACKGROUND: Barrett's oesophagus is a premalignant condition. Recent reports have suggested that laser coagulation or photodynamic therapy combined with acid suppression may induce reconstitution of squamous mucosa. However, a high percentage of residual glands remain in cases treated with both techniques. Argon plasma coagulation (APC) appears to be an attractive alternative to other thermoablative techniques. The aim of this study was to investigate the reconstitution of squamous epithelium in Barrett's oesophagus after APC. METHODS: Fifteen patients with histologically proven Barrett's oesophagus were included in a prospective study. After base-line documentation by videotaping and biopsies, Barrett's epithelium was treated by repeated APC at intervals of 4-6 weeks until complete squamous restoration was achieved. All patients were kept under high-dose proton pump inhibitor therapy. RESULTS: In 13 patients complete reconstitution of squamous epithelium was achieved. Buried glands after squamous restoration were detected transiently in only one case after the first session. As side effects seven patients had mild retrosternal discomfort. One patient reported severe retrosternal pain for 1 week. He then refused further APC sessions. Another patient was excluded because of noncompliance. During the follow-up period (6-13 months) recurrence of Barrett's epithelium was observed in one patient. CONCLUSIONS: APC is a suitable technique for achieving squamous restoration in Barrett's oesophagus. The rare occurrence of remaining buried glands may result from the homogeneous coagulation achieved by the ionized argon gas beam.     

Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial

BACKGROUND: Failure to adequately evacuate blood from the pleural space after trauma may result in extended hospitalization and complications such as empyema. METHODS: Patients with retained hemothoraces were prospectively randomized to either a second tube thoracostomy (group 1, n = 24) or video-assisted thoracoscopy (VATS) (group 2, n = 15). Group 1 patients in whom additional tube drainage failed were subsequently randomized to either VATS or thoracotomy. Study end points included duration and costs of hospitalization. RESULTS: During a 4-year period, 39 patients were entered into the study. Patients in group 2 had shorter duration of tube drainage (2.53 +/- 1.36 versus 4.50 +/- 2.83 days, mean +/- standard deviation; p < 0.02), shorter hospital stay after the procedure (3.60 +/- 1.64 versus 7.21 +/- 5.30 days; p < 0.02), and shorter total hospital stay (5.40 +/- 2.16 versus 8.13 +/- 4.62 days; p < 0.02). Hospital costs were also less in this group ($7,689 +/- 3,278 versus $13,273 +/- 8,158; p < 0.02). There was no mortality in either group. No group 2 patient required conversion to thoracotomy. In 10 group 1 patients additional tube placement failed, and this subset was randomized to VATS (n = 5) or thoracotomy (n = 5). No significant difference in clinical outcome was found between these subgroups. CONCLUSIONS: In many patients treated only with additional tube drainage (group 1), this therapy fails, necessitating further intervention. Intent to treat with early VATS for retained hemothoraces decreases the duration of tube drainage, the length of hospital stay, and hospital cost. Early intervention with VATS may be a more efficient and economical strategy for managing retained hemothoraces after trauma.     

Phosphatidylcholine coated chest drains: are they better than conventional drains after open heart surgery?

INTRODUCTION: Inadequate thoracic drainage after open heart surgery has serious deleterious consequences. Thrombus formation within the chest drains is primarily responsible for the occlusion of chest drains. Chest drains coated with derivatives of phosphatidylcholine (PC), commonest phospholipid on cell membranes, potentially have a less thrombogenic surface. MATERIALS AND METHODS: In a prospective randomised double blind study, we compared PC-coated drains (Group I, n = 25) with non coated drains (Group II, n = 26) after open heart surgery. Drain performance, post-operative complications and clinical course were compared. RESULTS: PC-coated drains had a significantly shorter period of drainage, 20.4 +/- 1.0 versus 28.9 +/- 3.7 h (P < 0.05). Otherwise, mean volume drained, number clots removed from drain and the ease of drainage of the two types of drains were similar. There were no significant differences in the incidence of post-operative pericardial effusions, dysrhythmias, ambulation time and hospital stay. CONCLUSIONS: We conclude that the PC coated drains may be of importance in cases where prolonged drainage is anticipated otherwise they have no significant advantage.     

Ayurveda''s role in preventing disease

PURPOSE: To assess the value of preoperative axillary sonography possibly malignant for breast tumours. METHOD: We performed preoperative axillary sonography on 89 patients with suspicious breast tumours. In 78 cases, among which there were 74 invasive carcinomas, the surgery that followed included an axillary lymph node dissection and a comparison with the histology was possible. RESULTS: The sonographic detection of axillary lymph node metastases has a sensitivity of 90% and a specificity of 91.7% in relation to all tumour stages and a sensitivity of 100% and specificity of 89.6% in relation to T1 tumours. In our analysis, therefore, it is vastly superior to a clinical examination of the axilla. CONCLUSION: Ultrasonography is an accurate imaging method for the diagnosis of axillary lymph node metastases. Broadening this analysis to include more patients will validate this conclusion. The results of our preliminary study suggest that this diagnostic method could help reduce unnecessary radical surgery in the treatment of breast cancer.     

Induction of apoptosis by tamoxifen and ICI 182780 in primary breast cancer

Hormonal breast cancer therapies have traditionally been considered cytostatic, but recent pre-clinical data suggest that anti-oestrogens can induce apoptosis. The aim of this study was to assess whether tamoxifen (TAM) and ICI 182780 (ICI) could induce apoptosis in human breast cancer, and whether this was related to oestrogen receptor status. We measured apoptosis in primary breast cancer patients before and after pre-surgical treatment with 20 mg/day TAM (study 1) or 6 or 18 mg/day ICI (study 2). In each study there was a randomised non-treatment (NT) control group. TAM significantly increased apoptotic index (AI) in ER+ but not in ER- tumours. There was a significant increase in AI following treatment with ICI. Insufficient pairs of samples were available to determine whether this change was confined to ER+ tumours, but in a cross-sectional analysis AI was significantly higher in excision biopsies for ICI-treated than NT patients for ER+ but not ER- tumours. Our results provide clinical evidence that apoptosis may be induced in ER+ primary breast cancer by both non-steroidal and steroidal anti-oestrogens.     

A method for vibratome sectioning of Golgi-Cox stained whole rat brain

We report a prospective evaluation of 100 patients who underwent laparoscopic fundoplication according to Toupet. All these cases where suffering from gastro-oesophageal reflux resistant to medical treatment or recurring after stopping it. Only one conversion into laparotomy was required. Perioperative morbidity (4%), mortality (0%), median hospital stay (4 days) and return to work (3 weeks) were lower than in case of open surgery in the literature. One year after the operation, clinical results were similar to those of laparotomy with 93% of patients free of symptoms. Excellent results of this technique lead us to assert that laparoscopic Toupet procedure is an interesting way of treating the gastro-oesophageal reflux that does not respond to medical treatment.     

Treatment of chondrosarcoma. A retrospective study at the Norwegian Radium Hospital

The authors present a retrospective analysis of 59 chondrosarcoma patients treated at the Norwegian Radium Hospital during the period 1981 to 1993. 31 patients were admitted with untouched tumour, seven after fine needle cytology and 20 after open biopsy or partial excision. One patient had recurrent local disease. Only 20% of the tumours were of high grade malignancy. 51 patients were treated by surgery. Reconstructions were performed in 16 patients, using allografts or endoprostheses. Amputations were performed in six cases and wide excision in 12 cases. In these 18 patients local recurrence appeared in one case, and two developed lung metastases. Only one of the 18 patients operated by amputation or wide excision has since died from chondrosarcoma. Marginal excisions were performed in 26 cases. Nine of these patients developed a local recurrence, five developed metastases and three have died. Six patients had partial excisions. Postoperative radiotherapy was given to one patient only. Five of the six are alive. In one case, the quality of the margins could not be evaluated. A total of 45 of the 51 patients treated for the primary tumour by surgery are alive. The median observation time is four years. Treatment of nonmetastatic chondrosarcoma should be surgical. Chondrosarcoma patients show wider variations in age, localization of tumour and tumour growth rate than patients with other bone sarcomas. Although wide excisions provide the best local control of any grade of malignancy, the mutilation or risk involved may be so great that some patients may benefit from marginal or even partial excision.     

Mitchell osteotomy for adolescent hallux valgus

BACKGROUND: Complications often follow if a choledochal cyst is treated simply by drainage, either internal or external. This study reviews 17 patients who had had previous cystoenterostomy (n = 9) or external drainage (n = 8) and who required reoperation and cyst excision. METHODS: The study was a retrospective review including ten women and seven men managed over 9 years. The indications for reoperation were stone formation (10 patients), pancreatitis (three), portal hypertension (two) and hepatic abscess (one); two patients were asymptomatic. RESULTS: Definitive surgery with cyst excision was possible in all patients who had previously had external cyst drainage and in seven of nine who had had previous cystoenterostomy. There were no deaths. Two postoperative biliary leaks and two duodenal fistulas resolved spontaneously. CONCLUSION: Excision of a choledochal cyst is possible and desirable even after a previous drainage operation. In severely ill patients with a complication of choledochal cyst, external drainage may be a preferable initial manoeuvre.     

Variation in labial shoulder geometry of metal ceramic crown preparations: a finite element analysis

BACKGROUND: The anatomic variation of the frontal sinus and frontal recess can create both a diagnostic and therapeutic challenge. Most cases of frontal sinus disease can now be treated by endoscopic approaches. For refractory cases or those with severe pathology, the microscopically controlled drainage (MCD) operation has at times been successful and spared the patient the morbidity of an external approach. The aim of this study was to evaluate microscopically controlled frontal sinus surgery in these difficult cases. MATERIAL AND METHODS: Prospective analysis was performed on the efficacy of MCD in patients for whom endoscopic sinus surgery had failed or in primary cases with severe pathology or unfavorable anatomy. The technique employs a self-retaining endonasal retractor and a diamond bur under microscopic visualization to remove solid bone (frontal spine) obstructing the sinus drainage and allow a wide opening of the frontal recess while causing minimal mucosal damage. Unilateral drainage (extended frontal sinus drainage operation), and in some cases bilateral drainage (median drainage procedure) is employed. RESULTS: With an average of 23 months of follow-up, over 90% of patients were either free of symptoms or substantially improved after the MCD procedure. Three patients required revision surgery (extend the opening into a median drainage procedure) for adequate relief of symptoms. CONCLUSIONS: The MCD procedure is highly successful in the treatment of frontal recess disease, particularly in those cases of severe pathology or difficult anatomy. It may be used in those cases refractory to standard endoscopic sinus surgery where an external approach and frontal sinus obliteration are contemplated. As with endoscopic sinus surgery, precise knowledge of the frontal recess and neighboring landmarks is critical, and adequate drainage with minimal mucosal disruption should be the goal.     

Types of medical lasers

The knowledge about different types of lasers and their potential use in medicine is presented. A very rapid development of laser technology in the world imposes a need for up-to-date information about the characteristics of different laser instruments. Without this kind of information it would be difficult to keep in touch with the latest developments in the world's technology. Different types of lasers have different indication range in the medical practice. An inquiry into the fundamental principles of lasers physics is an important prerequisite for successful application of this technology in medicine. Laser as a surgical knife has shown certain advantages over scalpel, electrocautery and cryosurgery, as the laser surgery is a noncontact method, bloodless, precise, with better visualization, minimal postoperative edema, painless healing, without complications. Although laser cannot entirely replace conventional surgical instruments, it is still the instrument of choice for treatment of numerous pathological conditions. The carbon dioxide laser is a highly precise, bloodless light scalpel used for incising and excising tissues and sealing small blood vessels. The infrared beam at 10,600 nm wavelength is absorbed by water and tissue destruction is due to the instantaneous vaporization at relatively low temperature of 100 degrees C. The beam seals blood vessels of up to 0.5 mm in diameter and if the beam is defocused, larger vessels may be controlled. The beam also seals lymphatics, possibly reducing the spread of tumour cells by this route, and seals nerve endings: there is no incidence of neuroma formation. Carbon dioxide laser has shown a great efficiency in otorhinolaryngology, in maxillo-facial surgery and plastic surgery, in urology and gynecology. Provides true "no touch" surgery, and is used increasingly in neurosurgery for the precise atraumatic removal of tissue and for creation of precise lesions for the control of pain. The carbon dioxide laser beam cannot, at present, be transmitted via a flexible fibre, although a number of fibres are being investigated. Delivery of laser energy to microscope, colposcope or handpiece is via an articulated arm which is a hollow tube with mirrors at the articulations. The argon laser produces blue-green coherent light at a number of wavelengts but 80% of the energy is at wavelengths of 488 and 514 nm. This laser was first used in ophtalmology to treat diabetic retinopathy through, and without damage to, the clear anterior parts of the eye. The argon laser is used for blood vessel coagulation but can be used to perform slow, thermal tissue destruction at higher power levels. Argon laser is most commonly used in ophthalmology for otological micro-surgery, particularly in the treatment of otosclerosis and tympanosclerosis. Very good results have been achieved in the argon laser treatment of gastrointestinal bleeding ulcers, vascular lesions and polyps. Dermatology is another field where argon laser has shown great efficiency: hemangyomas, telangiectasias, tattoos, small benign and malignant tumours are amenable to argon laser treatment. In neurosurgery it is used to control both normal and abnormal blood vessels but at present much work on treatment of arteriovenous malformations and aneurysms is experimental. Both the argon laser energy can be transmitted via flexible fibre optic delivery system which can then be attached to an operating microscope, slit lamp, endoscope delivery fibre or handpiece. The Neodymium-YAG laser is used both for tissue destruction with good haemostasis and for the control of normal and abnormal blood vessels. This laser produces infrared coherent light at 1060 nm wavelength, which is deeply absorbed in the tissues without colour or tissue specificity. Neodymium-YAG laser is mostly used in tracheobronchial, gastrointestinal and urologic pathology in the treatment of stenoses, granulomas, benign tumours, and for reduction of malignant tumours. (ABSTRACT TRUN