Abstract
Partial and total splenectomies are associated with a high risk of substantial blood loss. Lasers operating at wavelengths strongly absorbed by water have the potential to improve hemostasis and cut while providing a narrow zone of thermal damage. The aim of this study is to compare a thulium-doped fiber laser (TDFL) emitting a wavelength of 1940 nm and a diode laser (DL) operating at 1470 nm for spleen surgery in a pig model. A partial splenectomy and spleen incisions were made in 12 animals using the two laser devices. The hemostasis was evaluated visually during surgeries. Post-mortem and histopathological evaluations were done on days 0, 7, and 14 following surgery. Neither TDFL nor DL caused bleeding on day 0 or delayed bleeding. On day 14, pale streaks at the site of incision were slightly wider after cutting with DL than with TDFL. Histological analysis revealed a carbonized zone with exudation and a deeper zone of thermal tissue damage on day 0. The width of the thermal changes was 655.26 ± 107.70 μm for TDFL and 1413.37 ± 111.85 μm for DL. On day 7, a proliferation of fibroblasts and splenocytes was visible, as well as a formation of multinucleated giant cells adjacent to the residues of carbonization. The zone of thermal damage was broader for DL (1157.5 ± 262.77 μm) than for TDFL (682.22 ± 116.58 μm). On day 14, cutting sites were filled with connective and granulation tissues with the residues of carbonization. The zone of thermal damage was narrower for TDFL (761.65 ± 34.3 μm) than for DL (1609.82 ± 202.22 μm). Thus, both lasers are efficient in spleen surgery, providing good hemostasis. However, TDFL produces a narrower zone of thermal damage, which suggests its better efficiency for spleen surgery, especially when performing more precise procedures.
Highlights
A significant percentage of spleen surgeries are performed to stop the hemorrhage caused by a traumatic rupture of the organ
The incision sites after cutting with thulium-doped fiber laser (TDFL) and diode laser (DL) had a similar appearance, forming carbonization streaks with an average width of 2 mm
TDFL tended to create narrower streaks of carbonization when compared with DL (Figure 1)
Summary
A significant percentage of spleen surgeries are performed to stop the hemorrhage caused by a traumatic rupture of the organ. Total splenectomy has been the method of choice for the treatment of severe splenic injuries. Other indications for surgical spleen removal include acquired hemolytic anemia, hypersplenism, autoimmune thrombocytopenia, myeloproliferative disorders, spherocytosis, spleen abscesses, cysts, tumors, and portal hypertension [1–3]. Partial splenectomy is indicated in children and in adults with specific disorders. Leaving 25% of the organ reduces hemolysis while maintaining the phagocytic function of the spleen [4,5]. The principles of treatment for spleen disorders have changed significantly
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