Fire: argon plasma coagulation, diathermy and laser.

Abstract

Interventional pulmonology offers a range of minimally invasive techniques to manage airway pathologies, including central airway obstruction. This review examines three commonly used hot ablation therapies: argon plasma coagulation (APC), diathermy and laser. These modalities play a crucial role in treating intrinsic central airway obstruction caused by both benign and malignant conditions, as well as managing haemoptysis by achieving effective haemostasis. APC is a non-contact technique that delivers ionised argon gas to coagulate tissue, making it useful for superficial lesions and bleeding. Diathermy applies high-frequency electric currents through direct tissue contact, allowing tumour debulking, resection and coagulation. Laser therapy is most commonly non-contact and uses the heat produced for cutting and coagulation. These techniques can be used independently or in combination with other bronchoscopy techniques, such as cryotherapy or mechanical debulking. While these procedures are widely available and generally safe, their use must be guided by patient factors, lesion location and risk of complications. Understanding their indications, contraindications and safety considerations is essential for optimising patient outcomes. This review provides a perspective on technique selection, safety considerations and procedural nuances.