Bonding surgical incisions using a temperature-controlled laser system based on a single infrared fiber

Abstract

ABSTRACT. Although there has been great interest in laser heating for bonding of surgical incisions in tissues, it has not gained wide acceptance by surgeons. We argue that the main obstacle has been the lack of temperature control, which may lead to a weak bonding. We previously developed a laser bonding system based on two infrared transmitting AgBrCl fibers, one for laser heating and one for temperature control. In view of the inherent limitations of such systems observed in many animal experiments, we developed an improved system based on a single infrared fiber. Besides the decreased dimensions, this system offers many advantages over the two-fiber system. It is less sensitive to accuracy of height and tilt of the fiber distal tip above the tissue, ensuring more accurate heating that can potentially lead to stronger bonding with minimal thermal damage. The system is successfully tested in the soldering of 15 corneal incisions, ex vivo. Histopathology shows little thermal damage and good wound apposition. The average burst pressure is 100±30 mm Hg. These findings indicate the usefulness of the system for ophthalmic surgery as well as other surgical procedures, including endoscopic and robotic surgery.

Strong bonding of corneal incisions using a noncontact fiber-optic laser soldering method

“…In addition to the experiments, we also carried out theoretical calculations of the temperature distribution during irradiation. 20,[23][24][25][26][27] We tested our calculations at different values of T and t and found optimal conditions for T ≈ 60°C and t ≈ 10 s. This was also verified experimentally, and strong and watertight bonding, without noticeable thermal damage, was obtained. 28 Using this information, we succeeded in soldering incisions in vitro in skin, 29 bowel, 30 dura, 31 and trachea.…”

Corneal cut closure using temperature-controlled CO2 laser soldering system

“…Silver halide fibers are used owing to their appropriate optical and mechanical properties. They are also nontoxic and water-insoluble, both important qualities in medical applications [25,27]. The target radiometric temperature at the corneal surface is 65°C, which was successfully maintained in the present study.…”

Temperature-controlled laser-soldering system and its clinical application for bonding skin incisions

“…With this system, we obtained excellent results for bonding of incisions in the cornea. 36 We expect that it will improve the bonding of skin incisions as well, shortening the procedure and perhaps resulting in even less scarring. Table 4 The pruritus score (1 = no pruritus, 10 = severe pruritus), comparing group I to group II, and comparing the total sutured wounds to all soldered wounds.…”