Novel Device for Tissue Cooling during Endoscopic Laryngeal Laser Surgery: Thermal Damage Study in an Ex Vivo Calf Model

Koo, Hae Jin; Burns, James A.; Kobler, James B.; Heaton, James T.; Zeitels, Steven M.

doi:10.1177/000348941212100710

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Previous publications have demonstrated that conventional surgical instruments are known to induce large lateral damage zones in soft tissue (steel scalpel, >400 μm; harmonic scalpel, >690 μm; monopolar electrosurgery, >160 μm; radiofrequency needle,> 150 μm; Er:YAG laser >600 μm; thulium laser 500–600 μm) . In contrast, the present study illustrates how PIRL soft tissue incision results in damage zones as narrow as 8.5 μm.…”

Section: Discussionmentioning

confidence: 99%

A novel tool in laryngeal surgery: Preliminary results of the picosecond infrared laser

Böttcher¹,

Clauditz²,

Knecht³

et al. 2013

The Laryngoscope

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Objectives/Hypothesis: Conventional lasers ablate tissue through photothermal, photomechanical, and/or photoionizing effects, which may result in collateral tissue damage. The novel nonionizing picosecond infrared laser (PIRL) selectively energizes tissue water molecules using ultrafast pulses to drive ablation on timescales faster than energy transport to minimize collateral damage to adjacent cells. Study Design: Animal cadaver study. Methods: Cuts in porcine laryngeal epithelium, lamina propria, and cartilage were made using PIRL and carbon dioxide (CO₂) laser. Lateral damage zones and cutting gaps were histologically compared. Results: The mean widths of epithelial (8.5 μm), subepithelial (10.9 μm), and cartilage damage zones (8.1 μm) were significantly lower for cuts made by PIRL compared with CO₂ laser (p < 0.001). Mean cutting gaps in vocal fold (174.7 μm) and epiglottic cartilage (56.3 μm) were significantly narrower for cuts made by PIRL compared with CO₂ laser (P < 0.01, P < 0.05). Conclusion: PIRL ablation demonstrates superiority over CO₂ laser in cutting precision with less collateral tissue damage

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Section: Discussionmentioning

confidence: 99%

A novel tool in laryngeal surgery: Preliminary results of the picosecond infrared laser

Böttcher¹,

Clauditz²,

Knecht³

et al. 2013

The Laryngoscope

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show abstract

“…Beer et al [ 12 ] showed in an in vitro study on pork liver using a 980-nm diode laser in micropulsed mode that water/air cooling during laser application has an effect on collateral tissue damage. Koo et al [ 13 ] examined whether a novel vortex cooling device that generates cooled air at low flow rates (3 l/min) provides a cooling benefit during simulated laryngeal laser surgery using a continuous-wave thulium laser. He showed by histologically examinations that this device was able to reduce the thermal tissue damage.…”

Section: Discussionmentioning

confidence: 99%

Heat dissipation after nonanatomical lung resection using a laser is mainly due to emission to the environment: an experimental ex vivo study

et al. 2013

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Laser-directed resection of lung metastases is performed more frequently in recent years. The energy-loaded laser rays heat up the lung tissue, considerably. It is still unclear which mechanism is more important for tissue heat dissipation: the lung perfusion or the tissue emission. Therefore, we created a special experimental model to investigate the spontaneous heat dissipation after nonanatomical lung resection using a diode-pumped laser with a high output power. Experiments were conducted on paracardiac pig lung lobes (n = 12) freshly dissected at the slaughterhouse. Nonanatomical resection of lung parenchyma was performed without lobe perfusion in group 1 (n = 6), while group 2 (n = 6) was perfused at a physiological pressure of 25 cm H2O at 37 °C with saline via the pulmonary artery. For this, we used a diode-pumped neodymium-doped yttrium aluminum garnet (Nd:YAG) LIMAX® 120 laser (Gebrüder Martin GmbH & Co. KG, Tuttlingen, Germany) with a wavelength of 1,318 nm and a power output of 100 W. Immediately after completing laser resection, the lungs were monitored with an infrared camera (Type IC 120LV; Trotec, Heinsberg, Germany) while allowed to cool down. The resection surface temperature was taken at 10-s intervals and documented in a freeze-frame until a temperature of 37 °C had been reached. The temperature drop per time unit was analyzed in both groups. Immediately after laser resection, the temperature at the lung surface was 84.33 ± 8.08 °C in group 1 and 76.75 ± 5.33 °C in group 2 (p = 0.29). Group 1 attained the final temperature of 37 °C after 182.95 ± 53.76 s, and group 2 after 121.70 ± 16.02 s (p = 0.01). The temperature drop occurred exponentially in both groups. We calculated both groups’ decays using nonlinear regression, which revealed nearly identical courses. The mean time of tissue temperature of >42 °C, as a surrogate marker for tissue damage, was 97.14 ± 26.90 s in group 1 and 65.00 ± 13.78 s in group 2 (p = 0.02). Heat emission to the environment surpasses heat reduction via perfusion in nonanatomically laser-resected lung lobes. In developing a cooling strategy, a topical cooling method would be promising.

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Ex vivo ovine model for head and neck surgical simulation

Ianacone

Gnadt

Isaacson

2016

American Journal of Otolaryngology

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Novel Device for Tissue Cooling during Endoscopic Laryngeal Laser Surgery: Thermal Damage Study in an Ex Vivo Calf Model

Abstract: Vortex cooling reduces thermal damage more effectively than room-air cooling or no cooling during both time-constant and depth-constant thulium laser cuts.

Cited by 3 publications

References 10 publications

A novel tool in laryngeal surgery: Preliminary results of the picosecond infrared laser

A novel tool in laryngeal surgery: Preliminary results of the picosecond infrared laser

Heat dissipation after nonanatomical lung resection using a laser is mainly due to emission to the environment: an experimental ex vivo study

Ex vivo ovine model for head and neck surgical simulation

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