Analysis of laparoscopic laser liver resection in standardized porcine model

Ellebrecht, David Benjamin; Theisen-Kunde, Dirk; Kuempers, Christiane; Keck, Tobias; Kleemann, Markus; Wolken, H.

doi:10.1007/s00464-018-6258-1

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…In another pig model of atypical liver resection with Tm:fiber laser emitting a wavelength of ~ 1.9 μ m in a contact mode a narrow scar width of approximately 1-2 mm after 14-16 days was also noted [ 24 , 25 ]. However, in a pig model of laparoscopic liver resection 11-15 days after surgery the total thermal damage zone exceeded 5 mm [ 26 ]. The differences might be attributed to the higher power used and other operating techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were observed by Theisen-Knude et al [ 25 ] in porcine model of partial liver resection with a 1.9 μ m thulium laser. An atypical partial hepatectomy by open and laparoscopic techniques did not result in significant bleeding or bile leakage, suggesting feasibility of the Tm:fiber laser in liver surgery [ 25 , 26 ]. Moreover, in experimental partial nephrectomy using Tm:fiber laser, good hemostasis was observed [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

Janeczek

Świderski

Czerski

et al. 2018

BioMed Research International

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Partial liver resection is a treatment of choice for liver tumors; the range of parenchyma excision varies from a small part of the tissue surrounding the neoplasm up to 70% of the organ. One of the major concerns during liver resection is blood loss. Thulium lasers which are characterized by the length of emission wave corresponding to a peak absorption of water create a new possibility of cutting tissues efficiently with minimal thermal damage and concurrently providing a good hemostasis control. The aim of our study was to evaluate an impact of liver transection with thulium doped fiber laser on an intraoperative bleeding and histopathological changes during postoperative period in swine model. Ten animals were subjected to open surgery partial liver resection and an incision of liver tissue with an all-fiber, diode-pumped, and continuous-wave Tm3+-doped fiber laser emitting 37.4 W of output power at ~1.94 μm wavelength. The macroscopic and histopathological evaluation was performed intraoperatively as well as 7 and 14 days after surgery. Macroscopically almost no bleeding was observed during surgery and no signs of bleeding were stated after 7 and 14 days. Histopathological analysis of the transection margin revealed a thermal damage area ranging in depth from 620.23 ± 23.82 μm on the day of surgery to 1817.70 ± 211.98 μm after 7 days. In the samples taken intraoperatively and after 7 days a superficial zone of carbonization was visibly separated from the deeper changes. After 14 days one 765.35 μm deep zone characterized by a granulation was present. In conclusion, thulium doped fiber laser is efficacious in cutting with a narrow zone of thermal injury and provides a good hemostasis during liver transection, thus being a potential tool for oncotic liver surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

Janeczek

Świderski

Czerski

et al. 2018

BioMed Research International

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“…Lasers have been successfully used in liver surgeries, whether in animal experiments or clinical trials, mainly because of their high selectivity and precision. 4,5,14,[26][27][28] However, for laser surgery, certain thermal effects can result in resection or ablation of the tissue, and excessive thermal damage may cause serious clinical consequences. Therefore, it is necessary to strictly control the thermal damage caused by lasers during surgeries.…”

Section: Discussionmentioning

confidence: 99%

Effects of water cooling on laser‐induced thermal damage in rat hepatectomy

Shan

Wang

et al. 2022

Lasers Surg Med

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High-powered lasers are commonly used for tissue resection in surgeries, including liver resection, medically known as hepatectomy; however, such lasers inevitably induce thermal damage that causes postoperative complications. This study aims to explore the effects of water cooling and different laser output modes on laser-induced thermal damage during hepatectomy. Methods: To avoid the influence of superposition, a 980-nm diode laser was used for a single-point hepatectomy. Eighteen Sprague-Dawley rats were used to explore the effects of water cooling and different laser output modes. A constant energy 10-J laser was used to cut the liver tissue with a power of 10 W and time of 1 second. The rats were randomly divided into six groups. The first three groups were assigned as test subjects for different laser output modes. Group 1 was operated with a continuous laser output for a duration of 1 second. Groups 2 and 3 were operated with a pulsed laser output for a duration of 1 second and a pulse width of 0.5 and 0.25 seconds, respectively. Groups 4, 5, and 6 were assigned for the water cooling test. Water cooling was performed based on the parameters of the first three groups. Medical saline (0.9% NaCl) was used for water cooling. The main observation indicators were resection efficiency and thermal damage, including the area of the thermal damage zone. Resection efficiency is calculated by dividing the resection area by the total thermal damage area. Results: In the three water cooling groups, the area of the resection, carbonized, sub-boiling coagulated, and total thermal damage zones were 0.0677, 0.00, 1.7293, and 2.2982 mm 2 in Group 4; 0.0465, 0.00, 1.3205, and 1.8414 mm 2 in Group 5; and 0.0565, 0.00, 1.4301, and 1.9650 mm 2 in Group 6, respectively. Compared with the first three groups, the water cooling groups exhibited significantly reduced thermal damage areas of in the carbonized, sub-boiling coagulated, and total thermal damage zones (p < 0.001 for all). In addition, there was no statistical difference in the resection area, vacuolated area, and resection efficiency. Furthermore, there was no statistical difference in the area of each thermal damage zone between the continuous and pulsed output groups. The resection efficiencies were 4.82%, 3.34%, 3.73%, 3.93%, 3.36%, and 3.01% in Groups 1 to 6, respectively. Moreover, there was no statistical difference (p > 0.05) in the resection efficiencies. Conclusion: Water cooling can reduce the total laser-induced thermal damage area and prevent tissue carbonization. Therefore, this cooling method can be used as a simple and safe strategy for controlling thermal damage during hepatectomy.

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“…Several studies have used porcine models to establish novel strategies for HCC treatment. For example, Cressman et al [11] attempted thermoembolization with transcatheter chemistry, while Ellebrecht et al [12] reported laparoscopic laser liver resection in normal porcine models. These…”

Section: Discussionmentioning

confidence: 99%

Development of human hepatocellular carcinoma in X-linked severe combined immunodeficient pigs: An orthotopic xenograft model

et al. 2021

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Hepatocellular carcinoma (HCC) is the fifth most common primary tumor and the third leading cause of cancer-related deaths worldwide. Rodent models of HCC have contributed to the advancement of studies investigating liver carcinogenesis, tumor-host interactions, and drug screening. However, their small size renders them unsuitable for surgical or clinical imaging studies, necessitating the development of larger-size HCC models. Here, we developed a xenograft model of human HCC in X-linked interleukin-2 receptor gamma chain gene (Il2rg)-targeted severe combined immunodeficient (SCID) pigs. HepG2 cell suspension in serum-free medium containing 50% membrane matrix was directly injected into the liver parenchyma of eight X-linked Il2rg-targeted SCID pigs (6.6–15.6 kg) via ultrasonography-guided percutaneous puncture. Tumor engraftment was evaluated weekly using ultrasonography, and cone-beam computed tomography was performed during arterial portography (CTAP) and hepatic arteriography (CTHA) to evaluate the hemodynamics of engrafted tumors. The engrafted tumors were histologically analyzed following necropsy and assessed for pathological similarities to human HCCs. Macroscopic tumor formation was observed in seven of the eight pigs (simple nodular tumors in three and multinodular tumors in four). Engrafted tumors were identified as low-echoic upon ultrasonography and as perfusion-defect nodules on the CTAP images. Meanwhile, CTHA showed that the tumors were hyperattenuating. Further, histopathological findings of the engrafted tumors were consistent with those of human HCC. In conclusion, the porcine model of human HCC, successfully generated herein, might help develop more effective therapeutic strategies for HCC.

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Analysis of laparoscopic laser liver resection in standardized porcine model

Abstract: The 1.9-µm cw-laser device enables a safe and fast liver resection in an experimental pig model compared to a gold standard (ultrasound aspirator) laparoscopic liver resection method. Wound healing is not interfered by laser liver resection.

Cited by 5 publications

References 17 publications

Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

Effects of water cooling on laser‐induced thermal damage in rat hepatectomy

Development of human hepatocellular carcinoma in X-linked severe combined immunodeficient pigs: An orthotopic xenograft model

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