Fiber-Guided CO2 Laser Surgery in an Animal Model

Wang, Zhi; Devaiah, Anand K.; Feng, Lining; Dasai, Urmen; Shapira, Gil; Weisberg, Ori; Torres, David; Shapshay, Stanley M.

doi:10.1089/pho.2006.24.646

Cited by 17 publications

(12 citation statements)

References 8 publications

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“…The flexible CO 2 laser demonstrated consistency in the shape and size of the created lesion, greater depth of penetration with increased laser power, limited width of collateral injury, and complete or near-complete healing within a week [4, 5]. Furthermore, bleeding during laser dissection is minimal with the CO 2 laser [3, 6] as the laser may be retracted from the tissue for a wide superficial coagulative effect. In addition, the gas flow down the hollow fiber not only keeps the fiber cool but also evacuates smoke and debris from the field of view.…”

Section: Discussionmentioning

confidence: 99%

“…No difference in tissue response was found between the flexible CO 2 laser fiber bent to 90° and the straight laser fiber [3]. In porcine studies, the flexible CO 2 laser has been used via upper endoscopy to perform circumferential ablation of the esophagus, achieving a depth of ablation to the muscularis mucosa and submucosa layers [10], as well as mucosectomy of 2-cm segments in the esophagus and stomach with minimal damage to the muscularis propria [9].…”

Section: Discussionmentioning

confidence: 99%

“…With the CO 2 laser beam being only 315 µm in spot size as it exits the flexible fiber, the CO 2 laser is suitable for microsurgery where fine control of dissection and ablation is necessary. While the width of thermal injury to neighboring tissue is on the scale of millimeters with the Nd:YAG laser and electrocautery, the CO 2 laser exerts minimal collateral damage on the scale of only micrometers, which promotes rapid wound healing [3]. …”

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confidence: 99%

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Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Mittra

Wong

et al. 2011

Surg Endosc

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Background The CO2 laser’s unique wavelength of 10.6 µm has the advantage of being readily absorbed by water but historically limited it to line-of-sight procedures. Through recent technological advances, a flexible CO2 laser fiber has been developed and holds promise for endoluminal surgery. We examined whether this laser, along with injection of a water-based gel in the submucosal space, will allow safe dissection of the intestines and enhance the potential of this tool for minimally invasive surgery. Methods Using an ex vivo model with porcine intestines, spot ablation was performed with the flexible CO2 laser at different power settings until transmural perforation. Additionally, excisions of mucosal patches were performed by submucosal dissection with and without submucosal injection of a water-based gel. Results With spot ablation at 5 W, none of the specimens was perforated by 5 min, which was the maximum recorded time. The time to perforation was significantly shorter with increased laser power, and gel pretreatment protected the intestines against spot ablation, increasing the time to perforation from 6 to 37 s at 10 W and from 1 to 7 s at 15 W. During excision of mucosal patches, 56 and 83% of untreated intestines perforated at 5 and 10 W, respectively. Gel pretreatment prior to excision protected all intestines against perforation. These specimens were verified to be intact by inflation with air to over 100 mmHg. Furthermore, excision of the mucosal patch was complete in gel-pretreated specimens, whereas 22% of untreated specimens had residual islands of mucosa after excision. Conclusion The flexible CO2 laser holds promise as a precise dissection and cutting tool for endoluminal surgery of the intestines. Pretreatment with a submucosal injection of a water-based gel protects the intestines from perforation during ablation and mucosal dissection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Mittra

Wong

et al. 2011

Surg Endosc

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“…This new flexible fiber system overcomes many limits of rigid CO 2 lasers, such as the need for general anesthesia and difficulty exposing all areas of the head and neck (31). The flexible system’s greater control over laser angulation potentially results in decreased thermal damage to surrounding tissue (32).…”

Section: Comparing Types Of Lasersmentioning

confidence: 99%

Use of Lasers in Laryngeal Surgery

et al. 2010

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Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this paper, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been employed in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke’s edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon’s control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted in order to realize the full potential of this surgical tool.

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“…Current otolaryngologic applications include removal of malignancies of the upper aerodigestive tract [(2)], treatment of laryngeal polyps and papillomas [(2;3;4)], middle ear surgery [(5–10)], and tonsillectomy [(11–13)].…”

Section: Introductionmentioning

confidence: 99%

Penetration of CO₂ laser into the otic capsule using a hand‐held, flexible‐fiber delivery system

et al. 2009

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Background and Objective A new, flexible-fiber, CO2 laser deliver system has recently been introduced into clinical use. For ear surgery applications, no data has been reported correlating power settings to depth of penetration into otic capsule such as that which covers the cochlea. Our goal in this study was to document such. Study Design/Materials and Methods Eight (8) cadaveric temporal bones were procured as per our institution’s protocols. For each specimen, 9 different laser holes were burned into the bone overlying the cochlea using the flexible-fiber CO2 laser. Power settings were varied from 10–20 Watts in 2 Watt increments, and duration of exposure was either 100, 200, 300, 400, or 600 mSec. Each setting (power and duration) were tested on 2 specimens. Following laser exposure, each specimen was scanned in a microCT scanner and the depth of penetration measured from these images. Results Of the 72 laser shots, 8 were excluded due to double hits (4) or oblique hits (3) or complete penetration to perilymph (1). After excluding these 8, bone penetration was found to vary from 160 to 670μm based on power and time settings. Spearman analysis on ranked data showed that time had a greater impact on depth than power. The correlation coefficients for time and power were 0.84 (p = 0.013) and 0.40 (p < 0.001), respectively. Conclusion The flexible-fiber CO2 laser is useful in ear surgery for ablation of soft tissue and bone. However, higher power setting and longer pulse durations can lead to complete penetration of the otic capsule causing damage of underlying structures such as the facial nerve, horizontal semicircular canal, and cochlea.

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Fiber-Guided CO2 Laser Surgery in an Animal Model

Abstract: Our findings indicate that this fiber system, at least with the laser parameters used in this study, appears to be an effective and feasible alternative for CO(2) laser surgery. It has great potential for development of office-based surgery under local anesthesia.

Cited by 17 publications

References 8 publications

Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Use of Lasers in Laryngeal Surgery

Penetration of CO₂ laser into the otic capsule using a hand‐held, flexible‐fiber delivery system

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Fiber-Guided CO2 Laser Surgery in an Animal Model

Abstract: Our findings indicate that this fiber system, at least with the laser parameters used in this study, appears to be an effective and feasible alternative for CO(2) laser surgery. It has great potential for development of office-based surgery under local anesthesia.

Cited by 17 publications

References 8 publications

Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Use of Lasers in Laryngeal Surgery

Penetration of CO2 laser into the otic capsule using a hand‐held, flexible‐fiber delivery system

Contact Info

Product

Resources

About

Penetration of CO₂ laser into the otic capsule using a hand‐held, flexible‐fiber delivery system