Separate and combined use of Nd-YAG and carbon dioxide lasers in liver resections: A preliminary report

Abstract

A series of 15 patients have undergone liver resection by laser, 10 by use of the carbon dioxide laser alone, one with the neodymium-doped yttrium aluminium garnet laser (Nd-YAG) alone, and four with combined use. Partial and anatomical liver resections have been done without mortality or haemorrhagic complications, although initial haemostasis was always difficult with the CO2 laser alone. Bile leakage occurred in four patients, but it stopped spontaneously in three. Histology showed a necrotic zone less than 2 mm deep when the CO2 laser was used alone, but the zone was 5–6 mm deep with the Nd-YAG laser and 1.6–1.8 mm deep when the two were used in combination. Thus, the most effective cutting, with good haemostasis and minimum damage to the underlying liver, was achieved with the combined lasers. A precise superposition of the two spots was achieved with a new handpiece prototype.