title: The electrosurgical knife in an optimized intermittent cutting mode for the endoscopic treatment of benign web-like tracheobronchial stenosis.
abstract: The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue.
  
  
  OBJECTIVE
  To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser.
  
  
  METHODS
  Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode.
  
  
  RESULTS
  All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157 ± 93 days. There was an overall decrease observed in mean obstruction (P<.001). Improvements in FVC (P=.01), Raw (P=.0016) and RV/TLC (P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy (P<.001).
  
  
  CONCLUSIONS
  The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anti-coagulation effect.
authors.affiliation: Department of Pulmonary Medicine, Lungenklinik Hemer, Germany. beatrizamat@hotmail.com
authors.forename: Beatriz
authors.initials: B
authors.lastname: Amat
authors.forename: Albert
authors.initials: A
authors.lastname: Esselmann
authors.forename: Guenther
authors.initials: G
authors.lastname: Reichle
authors.forename: Hans-Juergen
authors.initials: HJ
authors.lastname: Rohde
authors.forename: Michael
authors.initials: M
authors.lastname: Westhoff
authors.forename: Lutz
authors.initials: L
authors.lastname: Freitag
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000601:surgery*; D001982:Bronchial Diseases / Q000601:surgery* / Q000628:therapy; D001999:Bronchoscopy / Q000379:methods*; D002404:Catheterization; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D004598:Electrosurgery / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D014135:Tracheal Stenosis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult