We are exploring infrared (IR) lasers as an alternative energy modality to radiofrequency (RF) and ultrasonic (US)
devices intended to provide rapid surgical hemostasis with minimal collateral zones of thermal damage and tissue
necrosis. Previously, a 1470-nm IR laser sealed and cut ex vivo porcine renal arteries of 1-8 mm in 2 s, yielding
burst pressures < 1200 mmHg (compared to normal systolic blood pressure of 120 mmHg) and thermal coagulation
zones < 3 mm (including the seal). This preliminary study describes in vivo testing of a laser probe in a porcine
model. A prototype, fiber optic based handheld probe with vessel/tissue clasping mechanism was tested on blood
vessels < 6 mm diameter using incident 1470-nm laser power of 35 W for 1-5 s. The probe was evaluated for
hemostasis after sealing isolated and bundled vasculature of abdomen and hind leg, as well as liver and lung
parenchyma. Sealed vessel samples were collected for histological analysis of lateral thermal damage. Hemostasis
was achieved in 57 of 73 seals (78%). The probe consistently sealed vasculature in small bowel mesentery,
mesometrium, and gastro splenic and epiploic regions. Seal performance was less consistent on hind leg vasculature
including saphenous arteries and bundles and femoral and iliac arteries. Collagen denaturation averaged 1.6 mm in
8 samples excised for histologic examination. A handheld laser probe sealed porcine vessels in vivo. With further
improvements in probe design and laser parameter optimization, IR lasers may provide an alternative to RF and US
vessel sealing devices.
Suture ligation with subsequent cutting of blood vessels to maintain hemostasis during surgery is time consuming and skill intensive. Energy-based electrosurgical and ultrasonic devices are often used to replace sutures and mechanical clips to provide rapid hemostasis and decrease surgery time. Some of these devices may create undesirably large collateral zones of thermal damage and tissue necrosis, or require separate mechanical blades for cutting. Infrared lasers are currently being explored as alternative energy sources for vessel sealing applications. In a previous study, a 1470-nm laser was used to seal vessels 1 to 6 mm in diameter in 5 s, yielding burst pressures of ∼500 mmHg . The purpose of this study was to provide vessel sealing times comparable with current energy-based devices, incorporate transection of sealed vessels, and demonstrate high vessel burst pressures to provide a safety margin for future clinical use. A 110-W, 1470-nm laser beam was transmitted through a fiber and beam shaping optics, producing a 90-W linear beam 3.0 by 9.5 mm for sealing (400 W/cm 2 ), and 1.1 by 9.6 mm for cutting (1080 W/cm 2 ). A two-step process sealed and then transected ex vivo porcine renal vessels (1.5 to 8.5 mm diameter) in a bench top setup. Seal and cut times were 1.0 s each. A burst pressure system measured seal strength, and histologic measurements of lateral thermal spread were also recorded. All blood vessels tested (n=55 seal samples) were sealed and cut, with total irradiation times of 2.0 s and mean burst pressures of 1305±783 mmHg . Additional unburst vessels were processed for histological analysis, showing a lateral thermal spread of 0.94±0.48 mm (n=14 seal samples). This study demonstrated that an optical-based system is capable of precisely sealing and cutting a wide range of porcine renal vessel sizes and, with further development, may provide an alternative to radiofrequency- and ultrasonic-based vessel sealing devices.
Suture ligation with subsequent cutting of blood vessels to maintain hemostasis during surgery is time consuming
and skill intensive. Energy-based, electrosurgical and ultrasonic devices are often used to replace sutures and
mechanical clips to provide rapid hemostasis, and decrease surgical time. Some of these devices may create
undesirably large collateral zones of thermal damage and tissue necrosis, or require separate mechanical blades for
cutting. Infrared lasers are currently being explored as alternative energy sources for vessel sealing applications. In
a previous study, a 1470-nm laser was used to seal vessels of 1-6 mm in diameter in 5 s, yielding burst pressures of
~ 500 mmHg. The purpose of this study was to provide faster sealing, incorporate transection of the sealed vessels,
and increase the burst pressure. A 110-Watt, 1470-nm laser beam was transmitted through a fiber and beam shaping
optics, producing a linear beam 3.0 mm by 9.5 mm for sealing, and 1.1 mm by 9.6 mm for cutting (FWHM). A twostep
process sealed then transected ex vivo porcine renal vessels (1-8.5 mm diameter) in a bench top setup. Seal and
cut times were 1.0 s each. A standard burst pressure system measured resulting seal strength, and gross and
histologic thermal damage measurements were also recorded. All blood vessels tested (n = 30) were sealed and cut,
with total irradiation times of 2.0 s, mean burst pressures > 1000 mmHg (compared to normal systolic blood
pressure of 120 mmHg), and combined seal/collateral thermal coagulation zones of 2-3 mm. The results of this
study demonstrated that an optical-based system is capable of precisely sealing and cutting a wide range of porcine
renal vessel sizes, and with further development, may provide an alternative to radiofrequency and ultrasound-based
vessel sealing devices.
When using simulations to determine electrode geometry and energy deposition patterns for TURP devices, a
dominating factor for consideration is the tissue resection rate of the proposed system. While it is well understood that
the vaporization of biological tissue is the mechanism of tissue division, previous models have been unable to match
experimental results for a given applied power. Whether modeled as direct tissue/electrode contact or through the spatial
transform of arcing, the predicted division rate was significantly lower than that observed though experiment.
For the present study, heating rate was again used to determine the vaporization rate during the resection. This model
assumes that in order for the wire loop to advance not all of the tissue in front of the electrode must be vaporized but the
centerline of the advance must have sufficient energy deposited to divide the tissue. Integrating the volumetric energy
deposition rate along this centerline in front of the advancing electrode provides a comparison to the required
vaporization energy density resulting in a predicted time necessary for reaching the tissue division threshold.
Using the simulation results for a standard TURP electrode and various power settings, five cases were compared to
experimental results using in vitro bovine prostate tissue. Each tested at three cutting rates, evaluating the ability to
advance through the tissue. The simulation predicted tissue division rates in good agreement with those seen via
experiment, although the predicted values biased slightly higher suggesting that further mathematical model refinements
are necessary.
Access to the requested content is limited to institutions that have purchased or subscribe to SPIE eBooks.
You are receiving this notice because your organization may not have SPIE eBooks access.*
*Shibboleth/Open Athens users─please
sign in
to access your institution's subscriptions.
To obtain this item, you may purchase the complete book in print or electronic format on
SPIE.org.
INSTITUTIONAL Select your institution to access the SPIE Digital Library.
PERSONAL Sign in with your SPIE account to access your personal subscriptions or to use specific features such as save to my library, sign up for alerts, save searches, etc.