Development and evaluation of a scoring system for assessing incisions in laser surgery

Abstract

The idea of laser surgery is nearly as old as the laser itself. From the first trials to modern laser surgery systems, it was and is the aim to selectively cut the tissue in the focus spot without causing harm to surrounding structures. This is only possible when the correct parameters for the surgical laser are chosen. Usually, this is done by parameter studies. However, the concrete evaluation scheme often differs between groups and more precise approaches require staining and microscopic evaluation. To overcome these issues, a macroscopic scoring system is presented and evaluated. It can be shown that the scoring system works well and, thus, a laser cut can be evaluated within a few seconds. At the same time, the whole cutting front is taken into account. The presented scoring system is evaluated by the intra class correlation (ICC). The final agreement between different raters is more than 0.7. Therefore, the scoring system can be used to optimize and evaluate the cutting process and it should be suitable for comparing the results between different groups. Definitely, it can be applied for scoring within a group to enable e.g., a profound statistical analysis for a parameter study.

Relevant parameters for laser surgery of soft tissue

“…Experiment A For the quantitative analysis all cuts scored on the scoring system presented in a previous paper 30 from our group (especially Fig. 2 provides an good overview).…”

“…The cut shown there would be scored as 2. As it could be shown that the scoring of the cutting front is more reliable 30 , the complete analysis in the study is based on the scores of the cutting front.…”

“…As it could be shown that the scoring of the cutting front is more reliable 30 , the complete analysis in the study is based on the scores of the cutting front.

Figure 2 Exemplary scoring for the five different cuts (taken from our previous publication 30 ).

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“…In total, seven potential influencing parameters that affect the laser surgery process can be identified from the literature: wavelength, pulse duration, water cooling, air cooling, laser power, laser scan speed and laser line energy. To quantify the quality of the cut, the previously published scoring system 30 was used. With the help of the scoring system, all previously mentioned parameters, except wavelength and type of cooling, will be investigated in this study because studying the influence of wavelength would require too many different lasers and water cooling is known to result in a significant improvement in cut quality at the cost of increased complexity 31 , 32 and longer cutting times.…”

“…Non-laser parameter Laser parametersFigure2. Exemplary scoring for the five different cuts (taken from our previous publication30 ). Vol:.…”