Local Effects of a 1940 nm Thulium-Doped Fiber Laser and a 1470 nm Diode Laser on the Pulmonary Parenchyma: An Experimental Study in a Pig Model.

Maciej Janeczek,Maciej Dobrzyński,Zbigniew Rybak,Jolanta Bujok,Maria Szymonowicz,Jacek Świderski,Bogusława Żywicka,Albert Czerski,Anna Lipińska

doi:10.3390/ma14185457

Abstract

The lungs are a common site of metastases from malignant tumors. Their removal with a minimal but safe tissue margin is essential for the long-term survival of patients. The aim of this study was to evaluate the usefulness of a 1940 nm thulium-doped fiber laser (TDFL) and a 1470 nm diode laser (DL) in a pig model of lung surgery that involved the incision and excision of lung tissue. Histopathological analysis was performed on days 0 and 7 after surgery. Neither TDFL nor DL caused significant perioperative or postoperative bleeding. Histological analysis revealed the presence of carbonized necrotic tissue, mixed fibrin–cellular exudate in the superficial zone of thermal damage and bands of deeper thermal changes. The mean total width of thermal damage on day 0 was 499.46 ± 61.44 and 937.39 ± 109.65 µm for TDFL and DL, respectively. On day 7, cell activation and repair processes were visible. The total width of thermal damage was 2615.74 ± 487.17 µm for TDFL vs. 6500.34 ±1118.02 µm for DL. The superficial zone of thermal damage was narrower for TDFL on both days 0 and 7. The results confirm the effectiveness of both types of laser in cutting and providing hemostasis in the lungs. TDFL caused less thermal damage to the lung parenchyma than DL.

Highlights

The lungs are a common site for malignant tumor metastases [1]
The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser operating at a 1318 nm wavelength has been utilized both in experimental and clinical studies [8,9,10,11,12]
The aim of our study was a comparative analysis of the effect of lung cutting and resection in a pig model using a continuous-wave Tm3+ full-fiber diode pumped 1940 nm laser (TDFL) and 1470 nm diode laser (DL) on the degree of pulmonary tissue damage and bleeding peri- and postoperatively

Summary

Introduction

These range from minimally invasive video-assisted thoracic surgery (VATS) to invasive thoracotomy, during which either anatomical or non-anatomical resections are performed [2,3,4,5]. Electrocauteries have excellent cutting properties but typically do not provide adequate hemostasis in lung tissue, which necessitates additional suturing or the use of surgical sealants [6,7]. An increased wavelength of the emitted laser light compared to 1064 nm Nd:YAG lasers seems to provide better surgical outcomes in terms of cutting and coagulation efficacy [11,12]. Laser-assisted partial lung resection is mainly reported to be suitable in open surgery; case reports on laser-assisted

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Conclusion