Historical aspects of bronchoscopic CO₂ laser surgery

The initial use of the CO₂ laser was in the management of papilloma of the trachea and main bronchi. This work was preceded by work on experimental animals and was accomplished by means of an adaptor which fastened onto the CO₂ laser articulated arm and the bronchoscope. This instrument consisted of a rotating disc which reflected the beam down the bronchoscope and still allowed visualization by two openings in the disc. This instrument was considered too heavy and too bulky to use on humans and therefore a smaller, lighter unit was constructed which consisted of a reflector for the CO₂ beam, a reflector for the visual light coming back from the field of the bronchoscope so that vision and the CO₂ beam could be applied at the same instant. This also contained windows with thin plastic which only slightly resisted the CO₂ laser beam and prevented soiling of the interior of the adaptor and permitted an airtight closure which was helpful in the control of respiration. The laser is reflected down the bronchoscope and is not affected by the visual image being passed to the observer. In some versions of the presently available bronchoscopie adaptors the aiming light is transmitted along with the beam. This results in a better line-up between the aiming light and the bronchoscopie lesion, although it is not a necessary prerequisite.