Laser-assisted solder closure of bronchial stumps

Broncho-pleural fistula is a difficult clinical problem without a simple solution. Laser-assisted solder techniques potentially offer a means to precisely fix tissue glues into the fistulae through a bronchoscopic approach. Using a canine model, secondary bronchi were sealed with cryoprecipitate made from solvent/detergent treated plasma (treated to inactiviate membrane enveloped virus) mixed with indocyanine green (absorption 805 nm). Diode laser energy (emission 808 nm, 7.3 W/cm2) was applied to the solder until dessication was observed. Leakage pressures ranged between 18-86 mmHg with a mean of 46 + 24 mmHg. Laser-assisted solder techniques provide a reliably strong seal over leaking bronchial stumps and use of dye enhancement prevents undesired collateral thermal injury to surrounding bronchial tissue. Solvent/detergent plasma, prepared by methods shown to inactivate large quantities of HIV, HBV, and HCV, is an effective source of cyroprecipitate and should allow widespread use of pooled human material in a clinical setting.