High efficient bone ablation with diode pumped Erbium and Thulium lasers including different delivery fibers: a comparative in vitro study

Abstract

Er:YAG lasers (3μm) allow efficient bone ablation caused by the strong absorption in water. Unfortunately, there are only a few and comparable expensive fiber materials for this wavelength available which are suitable for high laser power. The bone ablation efficiency of the Tm:YAG laser is minor (2μm) but inexpensive silica fibers can be used. The aim of this study was to investigate the bone ablation, using novel diode pumped high power Er:YAG (laser power 40W) and Tm:YAG laser system (60W) and adaptive fiber delivery systems. Expected advantage of these lasers is the longer lifetime of the fibers because of the high repetition rate and low pulse energy compared to the flash lamp pumped laser systems. The bare fiber output ends of a sapphire fiber (Er:YAG laser) and of a silica fiber (Tm:YAG laser) were attached under water and a water filled container including the fixed sample (bovine bone slices) was moved by a computer controlled translation stage. In a second set-up we provided a focusing unit and appropriate water spray unit. The generated cut kerfs were analyzed by light microcopy and laser scanning microscopy. The results show that with the diode pumped Er:YAG laser and sapphire fiber a particular high efficient bone ablation (> 0.16mm2/J) is possible both with bare fiber under water and focusing unit with water spray. The higher power of the Tm:YAG laser also results in high ablation rates but causes enlarged thermal damages. In conclusion, this study demonstrates that efficient bone ablation is possible with both diode pumped laser systems. In terms of efficiency the Er:YAG laser is outstanding. The Tm:YAG laser also allows fast bone ablation, provided that the thermal impact is limited by effective cooling and high movement velocity of the laser spot, for example by using an automatic scanner.