A Experimental Study on Hemostatic Vascular Management Using an Nd: YAG Laser Bipolar Dissector

Abstract

The optical laser setting for successful hemostatic transection of vessels using Laser Bipolar Dissector (LBD) and the important factor in closure and the healing process of the vessel stump were examined in abdominal aortas, mesenteric arteries and femoral arteries of rabbits (n=40).Interluminal bursting pressures (BP) were measured. The cutting edges were harvested at one week (n=4), at 2, 3 and 4 weeks (n=4) and 6 months (n=4), and evaluated by light microscopy.Histopathological examinations were carried out by HEand EVG stainings.The BP immediately after transection at laser power of 10 (n,=5) and 13W (n=5) was above 346 mmHg, and that of 15W (n=5) and 20W (n=5) was 280mmHg, 208 mmHg respectively. The transected sites of vessels revealed well-apposed tissue welding of vascular wall. The welding of internal elastic lamina without fragmentation is histologically most important for closure of the vessel stump. An increase in the laser power from 10 to 20W resulted in increased severity of histopathological deterioration of tissue connectivity (n=10, p<0.01) and in decreased bursting strength (n=5, p<0.01). Laser power of 10 to 13W was the most suitable for hemostatic dissection of large vessels. In the healing process, cartilaginous foci (n=4) were observed in the vascular cutting edges at 4 weeks after LBD dissection, and osseous foci (n=---3) were observed at 6 months.These observations may suggest that use of the LBD for vascular transection results in excellent tissue welding of vascular stumps in 2 to 3mm diameter arteries and that the the vascular stump is repaired with the strengest tissue material.