OmniGuide photonic bandgap fibers for flexible delivery of CO 2 laser energy for laryngeal and airway surgery

Abstract

The CO 2 laser is the most widely used laser in laryngology, offering very precise cutting, predictable depth of penetration, and minimal collateral damage due to the efficient absorption of CO 2 laser by water. Surgical applications of CO 2 laser in microlaryngoscopy include removal of benign lesions and early-stage laryngeal cancer. A Transoral Laser Microsurgery (TLM) approach is routinely employed for treatment of laryngeal cancer; however, the role of TLM in advanced malignant lesions remains controversial. The main limiting factor of TLM is the restrictive exposure of the endoscopes combined with the limited cutting ability offered by the existing micromanipulator, enabling cutting only along the straight line-of-sight axis. A flexible fiber delivery system offering a very high quality output beam can offer tangential cutting and can therefore significantly enhance the existing surgical capabilities. Moreover, a flexible fiber for CO 2 laser delivery can be used for treatment of benign conditions through flexible endoscopy in an office setting using local anesthesia. OmniGuide Communications Inc. (OGCI) has fabricated a photonic bandgap fiber capable of flexibly guiding CO 2 laser energy. Results of laryngeal in-vivo and in-vitro animal studies will be presented. We will discuss the system setup, fiber performance and clinical outcomes. In addition we will present the results of the first human treatment and highlight additional otolaryngology conditions, which will likely benefit from the new technology herein presented.The CO 2 laser is the most widely used laser in laryngology, offering very precise cutting, precise depth of penetration and minimal collateral damage, due to the efficient absorption of the CO 2 laser wavelength by the water content of tissue. Surgical applications of the CO 2 laser in microlaryngoscopy include vocal cord nodules, polyps, hyperkeratosis, granulomas, arytenoidectomy, Reinke's edema, cysts, webs, and laryngeal stenosis. The CO 2 laser was first introduced in laryngology by Strong and Jako in 1972 [1], using the laser to treat vocal nodules, cysts, carcinoma in situ, and laryngeal papillomas. The latter, now more commonly referred to as "recurrent respiratory papillomas" (RRP), were the most important surgical application in the early years. In addition, clear-cut benefits were reported using the CO 2 laser to treat pediatric conditions such as subglottic hemangioma and stenosis [2][3][4]33]. Treatment of *

Reliability and efficacy of a new CO2 laser hollow fiber: a prospective study of 39 patients

“…1 The CO 2 laser hollow Wber can be used a with a hand piece for transoral microsurgery under general anesthesia b with a video endoscope or a Wbroscope for transnasal surgery under local anesthesia low optical-loss Wbers for CO 2 lasers that aVord reliability and power handling capacity suitable for many laser surgery applications. These Wbers have been nicknamed wave guide Wbers to reXect upon the radiation guiding mechanism by means of omnidirectional mirror structure around the Wber's hollow core [4,5]. The Wrst waveguide was developed by OmniGuide (Boston, MA) [6].…”

“…However, delivery of the laser beam via a micromanipulator mounted on the microscope makes access to some laryngo-pharyngeal regions challenging because the laser beam must travel to the tissue target in a straight line. To alleviate this issue, Xexible CO 2 hollow Wber waveguides were created [3][4][5]. The most recent product in the hollow Wber family is the FiberLase™ CO 2 laser waveguide (CO 2 LWG) (Lumenis, Santa Clara, CA).…”

Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors

“…These fibers have been nicknamed omniguide fibers to reflect upon the radiation guiding mechanism by means of omnidirectional mirror structure around the fiber's hollow core [16,17]. The first guide was developed by OmniGuide (Boston, MA, USA).…”

Phonosurgery: A review of current methodologies

“…In recent years, however, the development of a quartz flexible waveguide eliminated this drawback. 42,43 Another ablative laser used in laryngeal surgery is the thulium doped yttrium-aluminum-garnet laser (thul:YAG). 26,27,44 This laser produces an infrared beam similar to CO 2 but at 2013 nm wavelength.…”