Endobronchial Electrosurgery: Argon Plasma Coagulation and Electrocautery

Endobronchial electrosurgery is used to remove endobronchial lesions in the trachea and bronchi, using either a rigid or a flexible bronchoscope. The thermal property of electric current is used to destroy tissue or coagulate bleeding sites. Electrosurgery, electrocautery, electrotherapy, and surgical diathermy are terms often used when referring to the use of heat for tissue destruction. In this article, we specifically use the term electrocautery (EC) to describe an electrosurgical technique that requires probe-to-tissue contact whereby the conduction of electric current ionizes air resulting in tissue destruction or hemostasis or both. In contrast, argon plasma coagulation (APC) is a relatively new electrosurgical method whereby argon gas is ionized by an electric current to create a noncontact, homogeneous “bridge” to target tissue for coagulation or ablation. Both EC and APC are effective in ablating and coagulating tissue. In this article, we further elucidate the basic principles of electrosurgery; indications, complications, and techniques associated with both EC and APC; and how they compare with other standard endobronchial interventions, including mechanical debridement, laser photoresection, cryotherapy, photodynamic therapy (PDT), and brachytherapy

KEYWORDS

Electrosurgery - electrocautery - coagulation

REFERENCES

• 1 Turner J F, Wang K P. Clinics in Chest Medicine. Philadelphia; WB Saunders 1999: 107-122
• 2 Sheski F D, Mathur P M. Cryotherapy electrocautery and brachytherapy. Flexible bronchoscopy in the 21st century. In: Mehta AC Clinics in Chest Medicine Philadelphia; WB Saunders 1999: 123-138
• 3 Prakash U B, Offord K P, Stubbs S E. Bronchoscopy in North America: the ACCP Survey.  Chest. 1991;  100 1668-1675
• 4 Grund K E, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy.  End Surg. 1994;  2 42-46
• 5 Bergler W, Honig M, Gotte K, Petroianu G, Hormann K. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation.  J Laryngol Otol. 1997;  111 381-384
• 6 Brand C U, Blum A, Schlegel A, Farin G, Garbe C. Application of argon plasma coagulation in skin surgery.  Dermatology. 1998;  197 152-157
• 7 Reichle G, Freitag L, Kullmann H J, Prenzel R, Macha H N, Farin G. Argon plasma coagulation in bronchology: a new method-alternative or complementary?.  J Bronchol. 2000;  7 109-117
• 8 Crosta C, Spaggiari L, De Stefano A, Fiori G, Ravizza D, Pastorino U. Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstruction: early results in 47 cases.  Lung Cancer. 2001;  33 75-80
• 9 Keller C A, Hinerman R, Singh A, Alavarez F. The use of endoscopic argon plasma coagulation in airway complications after solid organ transplantation.  Chest. 2001;  119 1968-1975
• 10 Morice R C, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction.  Chest. 2001;  119 781-787
• 11 Vonk-Noordegraaf A, Postmus P E, Sutedja T G. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study.  Lung Cancer. 2003;  39 49-53
• 12 Platt R C. Argon plasma electrosurgical coagulation.  Biomed Sci Instrum. 1998;  34 332-337
• 13 Colt H G. Bronchoscopic resection of Wallstent-associated granulation tissue using argon plasma coagulation.  J Bronchol. 1998;  5 209-212
• 14 Sutedja T G, Postmus P E. Photodynamic therapy in lung cancer: a review.  Photochem Photobiol. 1996;  36 199-204
• 15 Strauss A A, Strauss S F, Crawford R A. Surgical diathermy of carcinoma of the rectum: its clinical end results.  JAMA. 1935;  104 1480-1484
• 16 Gilfoy F E. Primary malignant tumors of the lower third of the trachea: report of a case with successful treatment by electrofulgeration and deep x-rays.  Arch Otolaryngol. 1932;  16 182-187
• 17 Kernan J D. Carcinoma of the lung and bronchus: treatment with radon implantations and diathermy.  Arch Otolaryngol. 1933;  17 457-473
• 18 Moersch H J, Bowing H H. Primary carcinoma of the bronchus treated successfully with surgical diathermy.  Ann Surg. 1935;  102 989-994
• 19 Hooper R G, Jackson F N. Endobronchial electrocautery.  Chest. 1985;  87 712-714
• 20 Hooper R G, Jackson F N. Endobronchial electrocautery.  Chest. 1988;  94 595-598
• 21 Homasson J P. Endobronchial electrocautery.  Semin Respir Crit Care Med. 1997;  18 535-543
• 22 Van Boxem T J, Venmans B J, Schramel F M et al.. Radiographically occult lung cancer treated with fiberoptic bronchoscopic electrocautery: a pilot study of a simple and inexpensive technique.  Eur Respir J. 1998;  11 169-172
• 23 Sutedja T G, van Boxem T J, Schramel F M, van Felius C, Postmus P E. Endobronchial electrocautery is an excellent alternative for Nd:YAG laser to treat airway tumors.  J Bronchol. 1997;  4 101-105
• 24 Coulter T D, Mehta A C. The heat is on.  Chest. 2000;  118 516-521
• 25 Van Boxem T J, Muller M, Venmans B, Postmus P E, Sutedja T G. Nd:YAG laser vs. bronchoscopic electrocautery for palliation of symptomatic airway obstruction.  Chest. 1999;  116 1108-1112
• 26 Petrou M, Kaplan D, Goldstraw P. Bronchoscopic diathermy resection and stent insertion: a cost effective treatment for tracheobronchial obstruction.  Thorax. 1993;  48 1156-1159
• 27 Sutedja T G, van Kralingen K, Schramel F M, Postmus P E. Fiberoptic bronchoscopic electrosurgery for rapid palliation in patients with central airway malignancies: a preliminary report.  Thorax. 1994;  49 1243-1246
• 28 Lavandier M, Carre P, Rivoire B et al.. High frequency electrocautery in the management of tracheobronchial disorders.  Am Rev Respir Crit Care Med. 1996;  75 A477
• 29 Van Boxem T J, Westerga J, Venmans B J, Postmus P E, Sutedja T G. Tissue effects of bronchoscopic electrocautery.  Chest. 2000;  117 887-891