Letter to the Editor
AcuBlade® Laser System: A New Tool for Interventional Bronchoscopist
Sistema láser AcuBlade®: una nueva herramienta para el broncoscopista intervencionista
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id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography with the mediastinal window setting shows a mass in the right lower lobe, adjacent to the pleural surface. (B) Follow-up computed tomography with the lung window setting demonstrated reabsorption of the mass, with residual scarring. (C) Alveolar macrophages recovered by bronchoalveolar lavage. 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In patients unfit for surgery, endoscopic treatment is a valid alternative, providing relief from dyspnea and improvement of quality of life.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Combined endoscopic management includes radial incision of stenotic scar with laser or cold instruments, mechanical dilatation and stent placement in presence of tracheal ring fracture to prevent recurrence.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Shapshay et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> pioneered endoscopic dilatation in 1987, using a CO<span class="elsevierStyleInf">2</span> laser in patients with tracheal stenosis. Following this, use of the technique has increased, and is now standard in most hospitals.</p><p id="par0020" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> and ND:YAG lasers are generally used in the management of tracheal stenosis. The CO<span class="elsevierStyleInf">2</span> laser is a highly accurate cutting tool with causing scant thermal damage, but its main drawback is the difficulty of delivering the beam through the bronchoscope. The ND:YAG laser is easily used with a bronchoscope, but it is less precise and may cause surrounding thermal damage.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Digital Acublade Robotic Microsurgery Laser System (Lumenis<span class="elsevierStyleSup">©</span> Surgery) is a new generation of CO<span class="elsevierStyleInf">2</span> laser commonly used in phonomicrosurgery. The main advantages of AcuBlade compared to traditional CO<span class="elsevierStyleInf">2</span> are the possibility of setting the type of incision (straight, curved, or disk ablation; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), the minimal thermal damage, and the computer filtering that eliminates the operator's tremor without preventing its ability to guide the laser in the target zone.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Thus, resection with AcuBlade is as even as that achieved with cold instruments, but with the advantage of a bloodless operative field.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We used AcuBlade for the first time in the management of idiopathic subglottic stenosis in a 73-year-old female. The stenosis appeared as a circumferential fibrotic web-like lesion, lying 8<span class="elsevierStyleHsp" style=""></span>mm from vocal folds, with a length of 15<span class="elsevierStyleHsp" style=""></span>mm and airway lumen of 6<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0035" class="elsevierStylePara elsevierViewall">With AcuBlade, we achieved an even resection of the stenotic scar without injuring the tracheal epithelium, and restored the normal tracheal lumen. Thus, we decided against mechanical dilatation to avoid tracheal injury and against stent placement due to proximity to vocal folds. At 15-month follow-up, the patient was asymptomatic with normal spirometric values and a patent tracheal lumen.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the light of this experience, we used AcuBlade in another challenging case involving management of granulations complicating subglottic stent placement.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The lesions completely destroyed vocal folds with luminal stent obstruction. AcuBlade was able to create a precise haemostatic excision of granulations without injuring vocal folds. It allowed us to assure airway patency while avoiding other treatments such as arytenoidectomy or cordectomy with adverse effect on phonatry function.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally, AcuBlade may be a useful tool in the armamentarium of the interventional bronchoscopist. Compared to traditional lasers, it gives a highly uniform, hemostatic incision with minimal thermal spread. In addition, the type of incision can be adapted to the shape of lesion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fiorelli A, Mazzone S, Santini M. Sistema láser AcuBlade<span class="elsevierStyleSup">®</span>: una nueva herramienta para el broncoscopista intervencionista. Arch Bronconeumol. 2016;52:283–284.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1463 "Ancho" => 1551 "Tamanyo" => 121492 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">AcuBlade can perform different types of incision (straight, curved, or disk ablation) of varying length and depth, according to the shape of the lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A simple technique to control placement of Dumon stent in subglottic tracheal stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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Delos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-004-0746-8" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol" "fecha" => "2005" "volumen" => "262" "paginaInicial" => "113" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15007599" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel CO<span class="elsevierStyleInf">2</span> laser robotic controller outperforms experienced laser operators in tasks of accuracy and performance repeatability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y.T. Wong" 1 => "C.C. Finley" 2 => "J.F. Giallo 2nd" 3 => "R.A. Buckmire" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.21853" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2011" "volumen" => "121" "paginaInicial" => "1738" "paginaFinal" => "1742" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21792963" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The digital AcuBlade laser system to remove huge vocal fold granulations following subglottic airway stent" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Fiorelli" 1 => "S. Mazzone" 2 => "A. Mazzone" 3 => "M. Santini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivt226" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2013" "volumen" => "17" "paginaInicial" => "591" "paginaFinal" => "593" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23690432" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000005/v1_201604270052/S1579212915004218/v1_201604270052/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000005/v1_201604270052/S1579212915004218/v1_201604270052/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915004218?idApp=UINPBA00003Z" ]
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| 2020 December | 57 | 23 | 80 |
| 2020 November | 51 | 16 | 67 |
| 2020 October | 47 | 12 | 59 |
| 2020 September | 48 | 14 | 62 |
| 2020 August | 35 | 15 | 50 |
| 2020 July | 38 | 20 | 58 |
| 2020 June | 39 | 6 | 45 |
| 2020 May | 50 | 19 | 69 |
| 2020 April | 70 | 26 | 96 |
| 2020 March | 50 | 20 | 70 |
| 2020 February | 57 | 21 | 78 |
| 2020 January | 58 | 16 | 74 |
| 2019 December | 42 | 18 | 60 |
| 2019 November | 51 | 23 | 74 |
| 2019 October | 25 | 13 | 38 |
| 2019 September | 26 | 18 | 44 |
| 2019 August | 32 | 15 | 47 |
| 2019 July | 39 | 28 | 67 |
| 2019 June | 33 | 13 | 46 |
| 2019 May | 57 | 10 | 67 |
| 2019 April | 202 | 24 | 226 |
| 2019 March | 42 | 15 | 57 |
| 2019 February | 44 | 16 | 60 |
| 2019 January | 28 | 18 | 46 |
| 2018 December | 30 | 17 | 47 |
| 2018 November | 56 | 16 | 72 |
| 2018 October | 46 | 31 | 77 |
| 2018 September | 29 | 12 | 41 |
| 2018 May | 17 | 0 | 17 |
| 2018 April | 23 | 5 | 28 |
| 2018 March | 15 | 2 | 17 |
| 2018 February | 16 | 6 | 22 |
| 2018 January | 20 | 8 | 28 |
| 2017 December | 32 | 5 | 37 |
| 2017 November | 18 | 4 | 22 |
| 2017 October | 21 | 6 | 27 |
| 2017 September | 25 | 10 | 35 |
| 2017 August | 22 | 11 | 33 |
| 2017 July | 19 | 14 | 33 |
| 2017 June | 33 | 12 | 45 |
| 2017 May | 30 | 14 | 44 |
| 2017 April | 23 | 10 | 33 |
| 2017 March | 18 | 28 | 46 |
| 2017 February | 19 | 4 | 23 |
| 2017 January | 11 | 8 | 19 |
| 2016 December | 41 | 18 | 59 |
| 2016 November | 41 | 20 | 61 |
| 2016 October | 47 | 19 | 66 |
| 2016 September | 39 | 5 | 44 |
| 2016 August | 48 | 2 | 50 |
| 2016 July | 3 | 1 | 4 |
Show all
