Comparison of A 1940 nm Thulium-Doped Fiber Laser and A 1470 nm Diode Laser for Cutting Efficacy and Hemostasis in A Pig Model of Spleen Surgery

Abstract

Partial and total splenectomies are associated with a high risk of substantial blood loss. Lasers operating at wavelengths strongly absorbed by water have the potential to improve hemostasis and cut while providing a narrow zone of thermal damage. The aim of this study is to compare a thulium-doped fiber laser (TDFL) emitting a wavelength of 1940 nm and a diode laser (DL) operating at 1470 nm for spleen surgery in a pig model. A partial splenectomy and spleen incisions were made in 12 animals using the two laser devices. The hemostasis was evaluated visually during surgeries. Post-mortem and histopathological evaluations were done on days 0, 7, and 14 following surgery. Neither TDFL nor DL caused bleeding on day 0 or delayed bleeding. On day 14, pale streaks at the site of incision were slightly wider after cutting with DL than with TDFL. Histological analysis revealed a carbonized zone with exudation and a deeper zone of thermal tissue damage on day 0. The width of the thermal changes was 655.26 ± 107.70 μm for TDFL and 1413.37 ± 111.85 μm for DL. On day 7, a proliferation of fibroblasts and splenocytes was visible, as well as a formation of multinucleated giant cells adjacent to the residues of carbonization. The zone of thermal damage was broader for DL (1157.5 ± 262.77 μm) than for TDFL (682.22 ± 116.58 μm). On day 14, cutting sites were filled with connective and granulation tissues with the residues of carbonization. The zone of thermal damage was narrower for TDFL (761.65 ± 34.3 μm) than for DL (1609.82 ± 202.22 μm). Thus, both lasers are efficient in spleen surgery, providing good hemostasis. However, TDFL produces a narrower zone of thermal damage, which suggests its better efficiency for spleen surgery, especially when performing more precise procedures.

Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery—Comparative Study in Pig Model

“…Considering that the bleeding with both lasers was comparable and that the TDFL tended to ensure better hemostasis, it can be assumed that the deeper tissue damage by the diode laser is unfavorable. In our previous reports, we have shown that the thulium-doped fiber laser can efficiently cut parenchymal organs in pigs (i.e., liver and spleen), while producing minimal zones of thermal damage sufficient for hemostasis (maximum depth: 1157.5 µm on day 7 for spleen and 1818.7 µm on day 7 for liver) [26,27].…”

“…The beam quality for the output radiation was of high quality, allowing for its use in thin treatment probes (less than 50 µm in diameter). The design and detailed physical parameters of the laser have been described in detail elsewhere [8,26,27].…”

“…Kidney fragments were prepared as described previously [26,27]. Briefly, excised fragments and portions of the organ at the site of excision were fixed in 10% buffered formaldehyde solution and then cut into small blocks transversely to the cutting line and embedded in paraffin.…”

The use of Thulium-Doped Fiber Laser (TDFL) 1940 nm as an energy device in liver parenchyma resection, a-pilot-study in Indonesia

“…The use of TDFL in solid organ parenchyma surgery is still uncommon. Boguslawa et al, showed the zones of thermal tissues achieved by TDFL were narrower compared to Diode Laser and Nd:YAG laser, therefore TDFL laser seems to be an effective tool for precise surgical procedures with narrow and controlled zone of destruction of the adjacent tissue [ 11 ]. Maciej et al, showed the efficacy of TDFL in cutting with a narrow zone of thermal injury and provides good hemostasis during partial liver resection and liver tissue incision.…”

Addendum: Żywicka, B., et al. Comparison of a 1940 nm Thulium-Doped Fiber Laser and a 1470 nm Diode Laser for Cutting Efficacy and Hemostasis in a Pig Model of Spleen Surgery. Materials 2020, 13, 1167

“…The authors would like to add the following sentence to the “Funding” section of their article [ 1 ]:…”