Liver resection with the continuous wave carbon dioxide laser

Mullins, Fitzhugh; Jennings, B. R.; McClusky, L.; Woolf, Robert M.

doi:10.1097/00006534-196904000-00045

Cited by 4 publications

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“…Argon laser induced superficial lesion at any energy output. CO2 induced incisive injury, free of necrosis, but vessels with an internal diameter of more than 1 mm were not sealed [4,8,17]. Nd YAG laser caused gaining ground lesions, irregularily bordered, thermal diffusion extending to the nearby vessel pathways.…”

Section: Discussionmentioning

confidence: 96%

“…They are currently used in endoscopy via a flexible fiberoptic laser transmission system [15,18,19]. Hepatic surgery, by means of carbon dioxide (CO2), has been performed in monkeys [17,22], in pigs [14], in rats [12], in dogs [4,8,13], and also in man [7,11,20]. Surgical capabilities of Nd YAG and argon laser have been published in a few detailed experimental papers [1,6,9,10,14,16].…”

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confidence: 99%

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Experimental comparative study on morphological effects of different lasers on the liver

et al. 1982

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Three types of laser radiation were compared as to their capabilities in hepatic surgery using 17 New Zealand rabbits. In four animals, subtotal scalpel lobectomy was performed, the hepatic pedicle being clamped. Hemostasis is obtained by means of argon or Nd YAG laser as long as the internal diameter of the vessels encountered is less than 4.5 mm. Nd YAG laser requires a power output four times higher than argon laser to obtain hemostasis. In six animals limited resection was performed by means of Nd YAG and CO2 lasers. CO2 radiation supplied insufficient hemostasis whenever the vessel diameter was more than 1 mm despite an excellent cutting power. Nd YAG radiation created an important necrosis zone due to thermal diffusion. In seven animals various focal hepatic lesions produced by the three types of laser were compared. Argon laser induced superficial and regularly round lesion, Nd YAG laser deeper, cauliflower-like lesions with thermal diffusion following especially vessels. Veins presented thrombosis of their blood content and coagulation necrosis of their wall. The amount of glycogenic granulation decreased. The CO2 laser induced very sharp punctual lesion without necrosis. Electron-microscopic sections revealed faint shadowy liver cells closet to the thermal source and bubbled mitochondria containing disrupted critea around the lesion. In later lesions Nd YAG laser produced more extensive fibrosis than argon or CO2 laser. After first clinical trials we believe that laser irradiation is actually an adjuvant safety factor in current hepatic surgery, whereas the Nd YAG laser could be of real interest in metastatic carcinoma destruction in liver.

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

Experimental comparative study on morphological effects of different lasers on the liver

et al. 1982

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“…Any blood or bile on the cut surface absorbs part of the heat and reduces the thermal effect of the beam. Mullins et al (1968) andHall et al (1973) reported more effective haemostasis during experimental hepatic resections when the liver circulation was temporarily arrested: Mullins clamped both the portal vein and the hepatic artery while Hall compressed the proximal part of the lobe to be resected with a modified Moynihan clamp. In a preliminary study, we found that complete occlusion of the afferent hepatic vessels is not enough to assure a completely dry field, probably because of the backflow from the hepatic veins, as has been previously suggested (Verschueren, 1976).…”

Section: Discussionmentioning

confidence: 99%

Partial hepatectomies with a hand-held laser knife: An experimental study

Orda

Wiznitzer

Goldwasser

et al. 1977

Journal of British Surgery

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Fifteen mongrel dogs underwent a left lateral non-anatomical partial hepatectomy using a carbon dioxide laser, diathermy or a surgical scalpel. An original prototype of a compact hand-held laser was used and its effects were compared with those of the other two instruments. An improved dry cat surface was achieved by placing a rubber snare proximal to the planned incision. While no significant differences in the blood loss or in the operating time were found among the experimental groups, the laser beam sealed vessels of up to about 6 mm in diameter without any complementary suture ligatures, which were needed in the other groups. Histological studies revealed less tissue trauma in the sections performed by the laser and only slight secondary inflammatory reaction.

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“…Such incisions are relatively haemostatic, the end result being similar to cutting with surgical diathermy. Mullins, Jennings, and McClusky (1968) reported that the carbon-dioxide laser was capable of performing sublobar resections of the liver in Rhesus monkeys, provided that the hepatic circulation was arrested for the brief duration of the incision. Without performing the customary dissection with ligation of vessels their laser produced a dry incised liver surface that did not bleed subsequently.…”

Section: Discussionmentioning

confidence: 99%

Haemostatic incision of the liver: Carbon-dioxide laser compared with surgical diathermy

1971

Journal of British Surgery

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Liver resection with the continuous wave carbon dioxide laser

Cited by 4 publications

References 0 publications

Experimental comparative study on morphological effects of different lasers on the liver

Experimental comparative study on morphological effects of different lasers on the liver

Partial hepatectomies with a hand-held laser knife: An experimental study

Haemostatic incision of the liver: Carbon-dioxide laser compared with surgical diathermy

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