The optimization of laser prostatectomypart I: Free beam side fire coagulation

Abstract

Objectives. To study laser-tissue interaction and develop unifying principlesfor the optimization of free beam side fire neodymium:yttrium-aluminum-garnet (Nd:YAG) laser coagulation prostatectomy. Methods. The heating patterns and coagulation volumes created by different right angle deflecting fibers were studied at different wattages and times in potato and canine models. Results. In the potato, higher wattage resulted in deeper and more rapid heating. Thehigh power density fibers created lesions of smaller volume which increased less with rising wattage than those fibers of lower power density. In the canine model, carbonization decreased heat penetration, and “popcorn” decreased superficial temperature without altering lesion size as long as it occurred without carbonization. As lasing progressed, smaller incremental increases in coagulation depth were achieved. Conclusions. To optimize coagulation laser prostatectomy, the surgeon should operate at the highest wattage which does not cause carbonization. The visualized intraoperative laser-tissue interaction allows the adjustment of laser power during the case as needed.