XXXX : histopathologic and bronchoscopic comparison of electrosurgical, cryosurgical, and laser resection.

@entity3278 @entity82 @entity742 @entity33 @entity544 @entity5142 @entity850
Controversy continues over the optimal method of resecting @entity5142 . Electrosurgery, cryosurgery and laser resection have all had some clinical success. We sought to compare these treatment methods in experimentally-created @entity5142 . Subglottic strictures were created transbronchoscopically in newborn @entity742 by electrocoagulating a rim of mucosa. Four weeks later, all had 20 to 90% occlusion documented bronchoscopically. Control animals were found to have dense @entity82 in the cricoid area. Remaining experimental animals were treated with: (1) electrosurgical resection; (2) cryosurgical treatment; (3) @entity3278 -yag (Nd:Yag) laser at 20 watts; (4) Nd:Yag laser with 40 watts; or (5) @entity544 laser at 10 watts. Animals from each group were sacrificed at 5 and 30 days postresection and the tracheas were examined grossly and microscopically. Animals sacrificed at 30 days postresection were bronchoscoped at weekly intervals. Cryosurgical and electrosurgical resection resulted in 1-3 mm of thermal damage adjacent to the margin of resection at 5 days post-treatment. Mucosal ingrowth and healing were rapid and there was no development of @entity850 or damage to underlying structures. Use of the Nd:Yag laser resulted in 10-20 mm of surrounding damage in animals sacrificed at 5 days. At 30 days posttreatment, there was mucosal healing but extreme underlying damage and redevelopment of @entity850 at the level of treatment. The @entity544 laser-treated animals showed thermal damage present up to 2 mm in depth from resected areas at 5 days post-treatment. Mucosal regeneration proceeded rapidly. This study indicates that electrosurgical and cryosurgical resection for experimental @entity5142 create minimal thermal damage and are associated with comparably acceptable rates of @entity33 and healing. The @entity544 laser created comparable to slightly decreased thermal damage but suffers at present from lack of optimal visualization of the subglottic lesion.
