A New Modality for Minimally Invasive CO₂Laser Surgery: Flexible Hollow-Core Photonic Bandgap Fibers

Abstract

Carbon dioxide (CO2) lasers have become one of the most common surgical lasers due to excellent tissue interaction properties that offer precise control of cutting and ablation depth, minimal thermal damage to surrounding tissue, and good hemostasis. However, realization of the benefits offered by using surgical CO2 lasers in many endoscopic, minimally invasive surgical procedures has been inhibited by the absence of reliable, flexible fiber laser beam delivery systems. Recently, novel hollow-core photonic bandgap optical fibers for CO2 lasers were developed that offer high flexibility and mechanical robustness with good optical performance under tight bends. These fibers can be used through rigid and flexible endoscopes and various handpieces and will allow surgeons to perform delicate and precise laser surgery procedures in a minimally invasive manner. This paper describes the basic design of laser beam delivery system, different surgical fiber designs and their characteristics, and usage with existing surgical CO2 laser models. A few examples of successful CO2 laser surgeries performed with these fibers are presented.

High-contrast gratings for integrated optoelectronics

“…In particular, hollow-core optical waveguides / fibers are desirable for gas sensors and gas-based nonlinear optics because of the increased lengths for light-matter interaction [66,67], and for laser surgery to guide light in mid-to far-infrared wavelength regimes that lack low-absorption materials [68,69]. Chip-scale hollow-core waveguides are desirable because they enable cost-effective manufacturing of on-chip systems with the potential to monolithically integrate light sources, detectors and electronics.…”

Reliability and efficacy of a new CO2 laser hollow fiber: a prospective study of 39 patients

“…These Wbers have been nicknamed wave guide Wbers to reXect upon the radiation guiding mechanism by means of omnidirectional mirror structure around the Wber's hollow core [4,5]. The Wrst waveguide was developed by OmniGuide (Boston, MA) [6]. Based on our experience in this series and consistent with previous experience with carbon dioxide lasers in general, we Wnd that the Lumenis Fiberlase WG allows for precise cutting and eVective hemostasis of vessels 0.5 mm or less.…”

Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors

“…The first guide was developed by OmniGuide (Boston, MA, USA). It has been used in endoscopic skull base and pituitary surgery, endoscopic sinus and nasal procedures, transoral laryngeal microsurgery, treatment of tracheal stenosis, surgery for glottic and subglottic respiratory papillomas, and office-based respiratory papilloma procedures performed transnasally with flexible endoscopy [18].…”