Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy

Khoder, Wael; Zilinberg, Katja; Waidelich, Raphaela; Stief, Christian G.; Becker, Armin J.; Pangratz, Thomas; Hennig, Georg; Sroka, Ronald

doi:10.1117/1.jbo.17.6.068005

Cited by 31 publications

(28 citation statements)

References 32 publications

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“…[10][11][12] It has also been used in the areas of ophthalmology, 13,14 and neurology. 15 These studies characterized the device as a precise cutting tool causing well-defined thermal damage to ensure hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of 1940-nm Diode Laser in Tonsillectomy: Preliminary Report

Lee

Cho

et al. 2015

Medical Lasers

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Background and ObjectivesThe aim of this clinical feasibility study was to assess preliminary results regarding postoperative outcomes of tonsillectomy using a laser system emitting at 1940 nm. Materials and MethodsThis clinical feasibility trial included six patients suffering from chronic tonsillitis. Tonsillectomy was performed using a 1940 nm laser with 6 W of output power. Intraoperative scoring was performed by a surgeon rating the cutting capacity of the device (5 point scale, 1-5), as well as intraoperative bleeding (3 point scale, 0-2). Patient surveys of pain and the surgeon's reports on postoperative changes in the surgical field (11 point scale, 0-10) were also analyzed on postoperative day one, and after week(s) one and two. ResultsNo complications were observed in patients. The surgeon's mean rating on the cutting capacity of the laser was 4.33 ± 1.96. Bleeding was almost absent, with a mean blood loss of 2.3 ml. Postoperative pain abruptly decreased after postoperative week one (4.83 ± 2.23, 3.33 ± 2.65, 1.17 ± 0.75 at postoperative day one, week one, and week two, respectively), with a statistically significant difference observed between postoperative day one and week two (p=0.008). Two patients required additional pain relief for five days after postoperative week one. Swelling had decreased significantly by postoperative week one (p=0.004), with a score of nearly 0 by postoperative week two. The mean scores for changes in scarring were 4.83 ± 0.40, 2.83 ± 1.21, and 1.67 ± 2.07 at postoperative day one, week one, and week two. ConclusionA 1940 nm laser demonstrated excellent intraoperative performances and postoperative outcomes in tonsillectomy. In addition, conduct of more large-scale and comparative studies is warranted in order to elucidate the efficacy of this laser treatment for tonsillectomy. Key words

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of 1940-nm Diode Laser in Tonsillectomy: Preliminary Report

Lee

Cho

et al. 2015

Medical Lasers

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“…9 Studies of different ex vivo laserassisted LPN have been published. 10 However, few in vivo surgery series are available. 11 The aim of this study was to evaluate the application of diode laser in laparoscopic partial nephrectomy, and to question this technique in terms of ease of tumor excision and reduction of WIT.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Knezevic

Kuliš

Maric

et al. 2014

Photomedicine and Laser Surgery

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Objective: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). Background data: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. Patients and methods: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor £ 4 cm, predominant exophytic growth and intraparenchymal depth £ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. Results: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. Conclusions: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.

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“…Laser‐induced tissue ablation is also the aim of some endoscopic and laparoscopic laser‐assisted approaches . The smoke induced during laser surgery as well as during electro‐cautery imposes a persistent problem existing wherever such procedures are performed . The smoke has some undesirable effects depending on the surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Lasers have also been evaluated as a haemostatic knife during some laparoscopic surgeries and as an ablation instrument for endoscopic surgeries . There are two issues regarding surgical smoke in laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

In‐vitro investigations on laser‐induced smoke generation mimicking the laparoscopic laser surgery purposes

Khoder

Stief

Fiedler

et al. 2014

Journal of Biophotonics

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Intraoperative smoke-generation limits the quality of vision during laparoscopic/endoscopic laser-assisted surgeries. The current study aimed at the evaluation of factors affecting this phenomenon. As a first step, a suitable experimental setup and a test tissue model were established for this investigation. The experimental setup is composed of a specific sample container, a laser therapy component suitable for the ablation of model tissue at different treatment wavelengths (λ = 980 nm, 1350 nm, 1470 nm), a suction unit providing continuous smoke extraction, and a detection unit for smoke quantification via detection of light (λ = 633 nm) scattered from smoke particles. The ablation rate (AR) was calculated by dividing the ablated volume by the ablation time (60 sec). The laser-induced scattering signal intensity of the smoke (SI) was determined from time-charts of the signal intensity as a measure for vision, in addition a delay-time tdelay could be derived defining the onset of SI after the laser was switched on. The ratio SI/AR is used as a measure for smoke generation in relation to the ablation rate. Additionally the light transmission of the tissue samples was used to estimate their optical properties. In this set-up, smoke generation using λ = 980 nm as ablation laser wavelength was detected after a delay-time tdelay = (121.6 ± 24.8) sec which is significantly longer compared to the wavelengths λ = 1350 nm with tdelay = (89.8 ± 19.3) sec and λ = 1470 nm with tdelay = (24.7 ± 5.4) sec. Thus, the delay Experimental set-up consisting of sample container, laser therapy component, suction unit and scattered-light detection compartment. time is wavelength-dependent. The SI/AR ratio was significantly different (p < 0.001) for 1470 nm irradiation compared to 980 nm irradiation [SI/AR(1470) = (11.8 ± 2.6) · 10(3) vs. SI/AR(980) = (8.6 ± 2.0) · 10(3) ]. The ablation crater for 980 nm irradiation was comparable with 1470 nm irradiation, but the coagulation rim was thicker in the 980 nm case. In conclusion, it could be shown experimentally that smoke-generation depends on the wavelength used for laser ablation.

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Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy

Cited by 31 publications

References 32 publications

Evaluation of the Efficacy of 1940-nm Diode Laser in Tonsillectomy: Preliminary Report

Evaluation of the Efficacy of 1940-nm Diode Laser in Tonsillectomy: Preliminary Report

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

In‐vitro investigations on laser‐induced smoke generation mimicking the laparoscopic laser surgery purposes

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