Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

Abstract

Partial liver resection is a treatment of choice for liver tumors; the range of parenchyma excision varies from a small part of the tissue surrounding the neoplasm up to 70% of the organ. One of the major concerns during liver resection is blood loss. Thulium lasers which are characterized by the length of emission wave corresponding to a peak absorption of water create a new possibility of cutting tissues efficiently with minimal thermal damage and concurrently providing a good hemostasis control. The aim of our study was to evaluate an impact of liver transection with thulium doped fiber laser on an intraoperative bleeding and histopathological changes during postoperative period in swine model. Ten animals were subjected to open surgery partial liver resection and an incision of liver tissue with an all-fiber, diode-pumped, and continuous-wave Tm3+-doped fiber laser emitting 37.4 W of output power at ~1.94 μm wavelength. The macroscopic and histopathological evaluation was performed intraoperatively as well as 7 and 14 days after surgery. Macroscopically almost no bleeding was observed during surgery and no signs of bleeding were stated after 7 and 14 days. Histopathological analysis of the transection margin revealed a thermal damage area ranging in depth from 620.23 ± 23.82 μm on the day of surgery to 1817.70 ± 211.98 μm after 7 days. In the samples taken intraoperatively and after 7 days a superficial zone of carbonization was visibly separated from the deeper changes. After 14 days one 765.35 μm deep zone characterized by a granulation was present. In conclusion, thulium doped fiber laser is efficacious in cutting with a narrow zone of thermal injury and provides a good hemostasis during liver transection, thus being a potential tool for oncotic liver surgery.

The use of Thulium-Doped Fiber Laser (TDFL) 1940 nm as an energy device in liver parenchyma resection, a-pilot-study in Indonesia

“…Maciej et al states that TDFL had a very good cutting properties while the total depth of thermal changes in the liver tissue ranges from 0.62 to 1.82 mm depending on the time of evaluation. Similar width of the thermal damage zone (less than 2.0 mm) was reported in an experimental pig model for partial nephrectomy with TDFL [ 12 , 19 , 20 ]. TDFL also has potent local thermal effect resulting in its ability to cut and coagulate, thus providing hemostasis.…”

“…Maciej et al, showed the efficacy of TDFL in cutting with a narrow zone of thermal injury and provides good hemostasis during partial liver resection and liver tissue incision. TDFL operating at 1940 nm may be a potential tool in oncologic liver surgery, especially when healthy tissue sparing is a priority and small atypical excisions are performed [ 12 ].…”

Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery—Comparative Study in Pig Model

“…The beam quality for the output radiation was of high quality, allowing for its use in thin treatment probes (less than 50 µm in diameter). The design and detailed physical parameters of the laser have been described in detail elsewhere [8,26,27].…”

“…Kidney fragments were prepared as described previously [26,27]. Briefly, excised fragments and portions of the organ at the site of excision were fixed in 10% buffered formaldehyde solution and then cut into small blocks transversely to the cutting line and embedded in paraffin.…”

Comparison of A 1940 nm Thulium-Doped Fiber Laser and A 1470 nm Diode Laser for Cutting Efficacy and Hemostasis in A Pig Model of Spleen Surgery

“…A fiber laser with an active medium in the form of a thulium-doped (Tm 3+ ) optical fiber (TDFL) working at a wavelength of 1940 nm shows nearly 1000 times greater absorption by water when compared with lasers emitting light at 1064 nm (Nd: YAG laser). This feature enables precise tissue ablation with a small margin of coagulation, while laser radiation of a 1064 nm wavelength penetrates deeper into tissue with less controlled coagulation effects [16][17][18].…”