Combined Nd:YAG and Er:YAG lasers for real-time closed-loop tissue-specific laser osteotomy

Abbasi, Hamed; Bernal, Lina M. Beltrán; Hamidi, Arsham; Droneau, Antoine; Canbaz, Ferda; Guzman, Raphaël; Jacques, Steven L.; Cattin, Philippe C.; Zam, Azhar

doi:10.1364/boe.385862

Cited by 20 publications

(12 citation statements)

References 81 publications

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“…Further important system components such as integrating a high-power laser, the design of the parallel robot's legs and attachment to bone, or the large-scale guidance of the miniature parallel robot with a macrosystem are research topics per se and are referenced but not detailed in this work. Also, work on the challenges in the field of laser physics are not the focus of this paper and are presented elsewhere (e.g., high-power laser coupling efficiency into optical fibers [52], or real-time tissue differentiation [53]).…”

Section: Figurementioning

confidence: 99%

Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy

Eugster

Merlet²,

Gerig

et al. 2021

Robotica

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To overcome the physical limitations of mechanical bone cutting in minimally invasive surgery, we are developing a miniature parallel robot that enables positioning of a pulsed laser with an accuracy below 0.25 mm and minimizes the required manipulation space above the target tissue. This paper presents the design, control, device characteristics, functional testing, and performance evaluation of the robot. The performance of the robot was evaluated within the scope of a path-following experiment. The required accuracy for continuous cuts was achieved and reached 0.176 mm on the test bench.

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Section: Figurementioning

confidence: 99%

Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy

Eugster

Merlet²,

Gerig

et al. 2021

Robotica

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“…Promising results on the LIBS-based differentiation of various hard and soft tissues of the porcine head region have led to theoretical considerations of clinical laser surgery systems with tissue-specific laser ablation [ 9 , 10 , 11 , 12 ]. More recently, the potential synergistic effects of laser ablation and laser-assisted tissue detection have been substantiated by combining LIBS systems with tissue-ablating Er:YAG lasers [ 13 , 14 , 15 ]. However, research efforts on laser surgery systems with controlled tissue feedback in the head and neck region are currently limited to animal specimens and the use of nontumorous tissues [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, the potential synergistic effects of laser ablation and laser-assisted tissue detection have been substantiated by combining LIBS systems with tissue-ablating Er:YAG lasers [ 13 , 14 , 15 ]. However, research efforts on laser surgery systems with controlled tissue feedback in the head and neck region are currently limited to animal specimens and the use of nontumorous tissues [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Electrolyte Heterogeneity of Tissues in Mandibular Bone-Infiltrating Head and Neck Cancer Using Laser-Induced Breakdown Spectroscopy

Winnand,

Boernsen,

Ooms

et al. 2024

IJMS

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Laser-induced breakdown spectroscopy (LIBS) was recently introduced as a rapid bone analysis technique in bone-infiltrating head and neck cancers. Research efforts on laser surgery systems with controlled tissue feedback are currently limited to animal specimens and the use of nontumorous tissues. Accordingly, this study aimed to characterize the electrolyte composition of tissues in human mandibular bone-infiltrating head and neck cancer. Mandible cross-sections from 12 patients with bone-invasive head and neck cancers were natively investigated with LIBS. Representative LIBS spectra (n = 3049) of the inferior alveolar nerve, fibrosis, tumor stroma, and cell-rich tumor areas were acquired and histologically validated. Tissue-specific differences in the LIBS spectra were determined by receiver operating characteristics analysis and visualized by principal component analysis. The electrolyte emission values of calcium (Ca) and potassium (K) significantly (p < 0.0001) differed in fibrosis, nerve tissue, tumor stroma, and cell-rich tumor areas. Based on the intracellular detection of Ca and K, LIBS ensures the discrimination between the inferior alveolar nerve and cell-rich tumor tissue with a sensitivity of ≥95.2% and a specificity of ≥87.2%. The heterogeneity of electrolyte emission values within tumorous and nontumorous tissue areas enables LIBS-based tissue recognition in mandibular bone-infiltrating head and neck cancer.

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“…32 Although several methods have been used for depth monitoring and tissue differentiation, only a few have been implemented as feedback systems for laser osteotomy. In our earlier study, 33 we presented a streamlined integration of the Er:YAG laser and Nd:YAG laser for tissue differentiation and ablation. The tissue differentiation relied on the collected intensity of the generated plasma without spectrum analysis.…”

Section: Introductionmentioning

confidence: 99%

Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation

Hamidi,

Bayhaqi,

Drusová

et al. 2023

Lasers Surg Med

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ObjectivesThe study aimed to improve the safety and accuracy of laser osteotomy (bone surgery) by integrating optical feedback systems with an Er:YAG laser. Optical feedback consists of a real‐time visual feedback system that monitors and controls the depth of laser‐induced cuts and a tissue sensor differentiating tissue types based on their chemical composition. The developed multimodal feedback systems demonstrated the potential to enhance the safety and accuracy of laser surgery.Materials and MethodsThe proposed method utilizes a laser‐induced breakdown spectroscopy (LIBS) system and long‐range Bessel‐like beam optical coherence tomography (OCT) for tissue‐specific laser surgery. The LIBS system detects tissue types by analyzing the plasma generated on the tissue by a nanosecond Nd:YAG laser, while OCT provides real‐time monitoring and control of the laser‐induced cut depth. The OCT system operates at a wavelength of 1288 ± 30 nm and has an A‐scan rate of 104.17 kHz, enabling accurate depth control. Optical shutters are used to facilitate the integration of these multimodal feedback systems.ResultsThe proposed system was tested on five specimens of pig femur bone to evaluate its functionality. Tissue differentiation and visual depth feedback were used to achieve high precision both on the surface and in‐depth. The results showed successful real‐time tissue differentiation and visualization without any visible thermal damage or carbonization. The accuracy of the tissue differentiation was evaluated, with a mean absolute error of 330.4 μm and a standard deviation of ±248.9 μm, indicating that bone ablation was typically stopped before reaching the bone marrow. The depth control of the laser cut had a mean accuracy of 65.9 μm with a standard deviation of ±45 μm, demonstrating the system's ability to achieve the pre‐planned cutting depth.ConclusionThe integrated approach of combining an ablative laser, visual feedback (OCT), and tissue sensor (LIBS) has significant potential for enhancing minimally invasive surgery and warrants further investigation and development.

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Combined Nd:YAG and Er:YAG lasers for real-time closed-loop tissue-specific laser osteotomy

Cited by 20 publications

References 81 publications

Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy

Miniature parallel robot with submillimeter positioning accuracy for minimally invasive laser osteotomy

Assessment of the Electrolyte Heterogeneity of Tissues in Mandibular Bone-Infiltrating Head and Neck Cancer Using Laser-Induced Breakdown Spectroscopy

Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation

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