Does the TruBlue Laser Set Microlaryngoscopy Equipment on Fire? A Systematic Evaluation.

Introduction: The risk of fire during laser microlaryngoscopy is well known. However, limited information is available about fire risk with the novel TruBlue laser. This study systematically evaluates its interactions with common surgical supplies, offering valuable insights into safety considerations for surgeons.

Material and methods: We used experimental conditions to test the extent to which TruBlue laser energy produces smoke, perforation, or fire in Rüsch®, Medtronic™ and microlaryngeal endotracheal tubes and in surgical pledgets.

Results: Only the Microlaryngeal Tube (MLT) caught fire. Notably, it happened only when the laser fiber shifted on the tube's surface. Smoke emerged solely from the laser fiber applied to the Medtronic™ shaft and only during continuous contact mode. Cuff perforation and smoke emanating from the shaft occurred in three-quarters of the Rüsch® trials. The pledgets' radiopaque segment exhibited a greater combustibility than other segments (p < 0.01). In many of the pledget trials, faster smoke emission occurred with shorter laser-to-target distances (p < 0.05). Water-soaked pledgets displayed a reduced rate of smoke production (p < 0.01) and string division.

Conclusion: The Medtronic™ tube assures remarkable safety with a nonignitable shaft and low cuff ignition. The MLT poses the highest ignition risk. Cuff perforation risk is mitigated by maintaining a 0.3-cm distance from the laser fiber tip. Pledget fire risk is mitigated by positioning the radiopaque part away from the laser beam and by soaking the pledget with water. Laser division of the pledgets' string was common.

Level of evidence: NA Laryngoscope, 2024.