Surgical Carbon Dioxide Laser Research Articles

O102 Rapid evaporative ionisation mass spectrometry (REIMS) coupled with the hydrosurgical debridement system and the carbon dioxide surgical laser: a proof of concept study in porcine tissues

Abstract Introduction Rapid evaporative ionisation mass spectrometry (REIMS) is a tissue profiling technology that allows for rapid information. The successful integration of this technology with surgical devices can be beneficial for diagnostic, prognostic, and individualised treatment purposes. Objectives To access the feasibility of coupling REIMS with the hydrosurgical debridement device and the carbon dioxide surgical laser. Methods The 3D printing attachments and circuit connections were designed for device couplings. The aerosols generated from the hydrosurgical debridement device in terms of mist (applying to porcine liver vs kidney tissue samples), and the carbon dioxide laser in terms of smoke (applying to porcine liver vs kidney cortex vs kidney medulla) were collected for REIMS analysis. The abstract models for tissue classification were built from the obtained mass spectrometry data using the linear discriminant analysis (LDA) dimensional reduction technique. The abstract models were cross-validated and the real-time classifications of different tissue types were tested in both coupling platforms. Results The real-time spectral data signals were reliably achieved from both coupling platforms. For REIMS-hydrosurgical debridement coupling, the abstract model was successfully built from 804 spectra obtained from multiple porcine liver and kidney samples. The cross-validation resulted in 98.01% correct classification rate between the two types of tissue. For REIMS-carbon dioxide laser platform, the abstract model built from 1,454 spectra of porcine tissue samples (liver vs kidney cortex vs kidney medulla) demonstrated 94.36% correct classification rate of the three tissue types. Conclusion REIMS can be coupled with the hydrosurgical debridement device and the carbon dioxide surgical laser with accurate real-time classification of porcine tissues. These platforms have the potential for future translational applications in the clinical arena.

Treatment of Recurrent Multifocal Cutaneous Squamous Cell Carcinoma in an African Grey Parrot (Psittacus erithacus) with Intralesional Carboplatin in Poloxamer 407

A 16-year-old male Congo African grey parrot (Psittacus erithacus) was presented with an ulcerated wing mass that was excised and diagnosed on histopathology as squamous cell carcinoma (SCC). A second surgery was performed to completely excise the tumor margins, resulting in over 5 years of remission for the neoplasm. However, over the next 6 years the patient developed SCC in 3 new locations on the body, as well as 2 squamous papillomas. The 2 papillomas were surgically excised and did not recur. Due to their size and location, none of the 3 new SCCs were amenable to complete excision. Instead, the 3 SCCs were managed with a series of treatments with intralesional carboplatin in poloxamer 407 and carbon dioxide surgical laser debridements. This treatment regimen has resulted in long-term (52 months, 30 months, and 17 months) resolution for all 3 of the SCCs. The overall survival time for the patient, from the initial diagnosis to the time of this report, is over 2900 days. While being treated for the 3 SCCs, the African grey parrot had no overt signs of complications or adverse side effects.

A Surgical Carbon Dioxide Laser with an Electromagnetic Power Control System

In this work, the possibility of controlling radiation power of a surgical carbon dioxide laser using an electromagnetic control system is considered. It is demonstrated that the electromagnetic control system makes it possible to adjust the laser radiation power within a wide range, allowing thereby the same laser system to be used for various medical purposes. Experimental results on the impact of modulated laser radiation on biological tissues are presented.

Dynamic, three‐dimensional optical tracking of an ablative laser beam

Surgical resection remains the treatment of choice for brain tumors with infiltrating margins but is currently limited by visual discrimination between normal and neoplastic marginal tissues during surgery. Imaging modalities such as computed tomography, magnetic resonance, positron emission tomography, and optical techniques can accurately localize tumor margins. We believe coupling the fine resolution of current imaging techniques with the precise cutting of midinfrared lasers through image-guided neurosurgery can greatly enhance tumor margin resection. This paper describes a feasibility study designed to optically track in three-dimensional space the articulated arm delivery of a noncontact ablative laser beam. To enable optical tracking of the laser beam focus, infrared-emitting diodes (IREDs) were attached to a handpiece machined for the distal end of the articulated arm of a surgical carbon dioxide laser. Crosstalk between the ablative laser beam and the tracking diodes was measured. The geometry of the adapted laser handpiece was characterized to track an externally attached passive tip and the laser beam focus. Target localization accuracies were assessed for both instrument points-of-interest and the sources of tracking errors were investigated. Stray infrared laser light did not affect optical tracking accuracy. The mean target registration errors while optically tracking the laser handpiece with a passive tip and the laser beam focus were 1.31+/-0.50 mm and 2.31+/-0.92 mm, respectively, and were equivalent to the errors tracking a 24-IRED pen probe from Northern Digital in a side-by-side comparison. The majority of error during ablation tracking derived from registration accuracy between physical space and the defined space of the ablation phantom and from an inability to freehand align the laser focus with the target in a consistent manner. While their magnitudes depend on spatial details of the tracking setup (e.g., number and distribution of fiducial points, working distance from the camera, etc.), these errors are inherent to any freehand laser surgery.

Structural changes in dental enamel induced by high energy continuous wave carbon dioxide laser

The morphological changes in dental enamel exposed to a high energy continuous beam surgical carbon dioxide laser were studied with a wet-scanning electron microscope. Utilizing a 1 mm focused beam, energy levels of 5, 10, and 12.5 watts were applied to the external enamel surface of teeth for between 0.05 and 2 seconds. Subsequent examination showed melting and resolidification of the surface enamel. Examination in cross section revealed three different zones of change, which were consistent in thickness. The outer layer of melted and resolidified enamel approximates 100 microns in width, whereas the next zone of acid resistant amorphous enamel measures only 12 microns in width and the third zone of porous enamel measures approximately 110 microns in width. Though of no immediate practical value in dentistry, the exact physical chemical changes occurring in the enamel warrant further investigation.

How i do it: Head and neck and plastic surgery a targeted problem and its solution: Rhinoscleroma: Management by Carbon Dioxide Surgical Laser

How i do it: Head and neck and plastic surgery a targeted problem and its solution: Rhinoscleroma: Management by Carbon Dioxide Surgical Laser

A comparison of carbon dioxide laser, liquid nitrogen cryosurgery, and scalpel wounds in healing

With the carbon dioxide surgical laser, the liquid nitrogen cryoprobe, and the scalpel, wounds were created on the shaved abdomen of 24 rats, and the patterns of healing were studied. The laser wounds were the first to epithelialize, followed by the scalpel wounds, with the cryosurgery wounds the slowest to epithelialize. The results were confirmed histologically.

The carbon dioxide laser in soft tissue preprosthetic surgery

The surgical carbon dioxide laser has the ability to vaporize soft tissues with little bleeding, pain, swelling, or wound contraction. The laser was evaluated on 27 patients requiring soft tissue preprosthetic surgery, including frenectomies, tuberosity reduction, hyperplasia removal, and sulcus deepening. Surgery was performed on an ambulatory basis with no bleeding or infection. Swelling was minimal and pain, as measured on a linear pain scale, was moderate. One third of the patients required no analgesics. Wound contraction did occur but was less than is historically quoted for scalpel wounds. The carbon dioxide laser would appear to have advantages for soft tissue preprosthetic surgery that warrant further evaluation.

Proximal large-bore jet ventilation for laryngeal laser surgery.

The carbon dioxide surgical laser has made many open upper airway operations obsolete. However, new laser-related hazards have been encountered, the most serious of which is fire in the airway. Venturi jet ventilation removes that risk and provides an unobstructed surgical field. Indications and techniques for the use of jet ventilation with carbon dioxide laser surgery remain controversial, particularly whether jet ventilation should be used in papillomatosis or in the severely obstructed airway, and whether proximal and distal catheter techniques are equally safe and effective. We report the successful use of proximal large-bore Venturi jet ventilation in 327 consecutive patients undergoing microlaryngeal laser surgery. The technique is ideal for pediatric patients with subglottic stenosis or recurrent respiratory papillomas and has not caused distal seeding in the latter group. We recommend the use of low-pressure ventilation, even in relatively obstructed airways. The experimental evidence reported here corroborates the clinical viewpoint expressed; the technique is safe, simple, and uncomplicated if used with care.

The Endoscopic Management of Early Squamous Carcinoma of the Vocal Cord with the Carbon Dioxide Surgical Laser: Clinical Experience and a Proposed Subclassification

Sixteen patients with T1 vocal cord squamous cell carcinoma were treated with endoscopic laser excision during a 4-year period. Laser excision was the initial treatment in 11 patients, and it was used to treat 5 patients who had recurrence after radiotherapy. Postoperatively, 13 (81%) of the 16 patients had normal voices. Two patients with persistent postoperative hoarseness had had anterior commissure lesions and previous radiotherapy; the other patient had a subtotal cordectomy. One patient developed a subsequent new lesion 27 months after the initial laser treatment; he was successfully managed with a second endoscopic laser excision. Involvement of the anterior commissure or involvement of the vocal process with minimally invasive disease proved not to be a contraindication to laser excision. The overall results in this small series suggest that laser excision of T1 vocal cord carcinoma is an excellent method of treatment.

Laser-Assisted Vasal Anastomosis in the Rat and Man

In order to study the efficacy of laser-assisted vasal anastomosis (LAVA), a microscopic carbon dioxide surgical laser (Xanar) was utilized in the anastomoses of human vas deferens in vitro and the Sprague-Dawley rat vas deferens in vivo. The longitudinal tensile and internal hydrostatic pressure strengths of laser-assisted vasal anastomoses were compared to conventional microsurgical suture anastomoses in the human vas deferens. The LAVA group had a greater mean internal hydrostatic pressure strength (p < 0.001) and a lesser mean longitudinal tensile strength (p < 0.001) than the conventional microsurgical group.Further evaluation was performed in the Sprague-Dawley rat model, comparing post-operative fertility, patency, healing and sperm granuloma occurrence among four surgically treated groups and a control group: LAVA, conventional suture anastomosis, sham operated, and vasectomized. Light and scanning electron microscopic examination revealed equivalent healing in both the LAVA and conventional groups. Fertility was not statistically different in the LAVA, conventional, control, and sham operated groups. However, the incidence of gross sperm granulomas observed in the LAVA group (80%) was much higher than in the conventional suture anastomosis group (0%). In conclusion, laser-assisted vasal anastomosis is a fast and simple technique for vasal reanastomosis and was as successful (in pregnancies) as conventional suture anastomosis in producing fertility in rats undergoing vasal reanastomosis, but the incidence of sperm granuloma is higher.

Medulloblastoma in childhood: results of radical resection and low-dose neuraxis radiation therapy

This review concerns 22 children who were treated from 1980 through 1983 for medulloblastoma in the posterior fossa. Treatment included attempts at radical resection of the tumor and postoperative craniospinal radiation therapy, with 5000 to 5500 rads directed to the posterior fossa and 2500 rads to the remaining craniospinal axis. This lower radiation dose to the neuraxis was used to avoid late adverse effects upon the growing central nervous system of the children. Gross confirmation of total resection was obtained in 13 patients (the "total resection group"); however, nine patients had a subtotal resection leaving a small portion of the tumor extending into the cerebellar peduncles or the cerebellopontine angle, or else encasing the posterior inferior cerebellar artery (the "subtotal resection group"). Six patients in the total resection group demonstrated tumor extension into the cerebellar peduncles, which was removed by means of a surgical carbon dioxide laser without neurological sequelae. Biopsy of the arachnoid membrane from the cisterna magna and cytological examination of the cerebrospinal fluid (CSF) prior to manipulation of the tumor were carried out in 12 patients. All but one showed dissemination of medulloblastoma cells. Myelography and CSF cytological study were undertaken 2 months after radiation therapy in 12 patients and were positive in two. There were no case mortalities in the total resection group during the 24- to 67-month follow-up period, whereas the 1-year survival rate in the "subtotal resection group" was only 44.4%. This study suggests that medulloblastoma can be controlled with a low radiation dose to the neuraxis, should a grossly confirmed total resection be achieved at craniotomy.

The laser gingivectomy. The use of the CO2 laser for the removal of phenytoin hyperplasia.

A new technique for the removal of phenytoin hyperplasia using the carbon dioxide (CO2) surgical laser is presented as well as a review of laser physics and the current uses of the CO2 laser in dentistry. Twelve cases of phenytoin hyperplasia removed surgically by the CO2 laser are presented; hence a laser gingivectomy. Advantages of the procedure include lack of hemorrhage yielding a dry field, noncontact surgery, sterilization of the surgical area, prompt healing, minimal post operative discomfort, and minimal time spent to perform the procedure. At the present time the use of the laser in dentistry is new and limited. In the future the laser may offer an alternative or an advancement to current procedures now used in dentistry.

炭酸ガスレーザー照射による家ウサギ舌組織の変化に関する基礎的研究

A 2 mm spot size focused beam from a continuous wave surgical carbon dioxide laser with diameter, integrated with an operating microscope was used to evaporate the normal dorsal surfaces of rabbit tongues under different conditions. The immediate effects of irradiation with carbon dioxide laser on the dorsal surface of the tongue were studied macroscopically and microscopically, and wound healing was examined microscopically, 1, 3, 5, 7, 14 and 21 days after he laser irradiation. The results were as follows.1) The immediate change induced by a focused beam carbon dioxide laser was characterized by white coloration on the targetarea up to a laser emission of 1 Joul and by tissue defect formation when emission exceeded 2 Joul.2) Tissue defect was characterized by a cone shape, and the floor of the defective was portion was slightly elevated at its center in some cases. The margin of the defective portion was slightly elevated over surrounding normal tissue.3) The depth of tissue defect varied with output power and irradiation time. In the same output power, the depth of tissue defect was directly proportional to irradiation time.4) Microscopic findings immediately after the laser irradiation varied with irradiation conditions. At 5 watts 0.1·0.2·0.5 second and 10 watts 0.1 second laser irradiations, tissue damage was only seen at the prickle-cell layer of the mucosal epithelium and the basal layer was not damaged. At 5 watts·1.0 second, 10 watts·O.2 second, 15 watts·O.1·0.2 second and 20 watts 0.1 second laser irradiations, tissue damage was seen beyond the basement membrane and in the submucosal layer, but the muscle layer was not damaged. At 10 watts 0.5·1.0 second, 15 watts·0.5·1.0 second and 20 watts·0.2·0.5·1.0 second laser irradiations, the muscle layer was damaged.5) Wound healing differed according to the depth of tissue damage immediately after the laser irradiation mentioned above. Wound healing was fast and finished within 7 days after the laser irradiation in the group that tissue damage was limited only to the prickle-cell layer of the mucosal epithelium. In the group that tissue damage was seen beyond the basement membrane and in the submucosal layer, and did not extend to the muscle layer, wound healing finished within 14 days after laser irradiation, but in the group that tissue damage extended to the muscle layer, 21 days were necessary to complete wound healing.From these results, it is speculated that the carbon dioxide laser will be effective to remove superficial lesions of the oral mucosa and of benefit to oral and maxillofacial surgery.

The effects of the carbon dioxide surgical laser on oral tissues

The carbon dioxide laser has become more widely available in recent years and is now employed in many branches of surgery. It is important to understand its biological effect on oral tissues so that the likely response in patients can be predicted. However, little information has been published on the healing mechanism of oral wounds. A study of the healing of laser wounds at various sites in the mouth has been undertaken in a clinically analogous animal model and the results correlated with the findings in patients. A brief description is given of the role of the carbon dioxide laser in the management of oral mucosal disease.

Microsurgery of the fallopian tube with the carbon dioxide laser: eighty-two cases with follow-up.

In 1974 the carbon dioxide laser was adapted to the operating microscope for reconstructive pelvic surgery and the first 15 cases of laser tubal microsurgery were performed. The instrumentation and techniques were refined. A protocol was designed to test the efficacy of this surgical modality, and a new study was begun in 1980. Complete documentation of laparoscopic findings, surgical techniques, and pre- and postoperative hysterosalpingograms are kept on videotapes. Detailed descriptions of the surgical techniques employed in these cases are presented in this paper. Preliminary results are reported in terms of patency and pregnancy rates experienced to date. Eighty-two women experienced fertility enhancement laser microsurgery at the Reproductive Biology Center at F. Edward Hebert Memorial Hospital in New Orleans. Bilateral patency or patency of the only existing fallopian tube was demonstrated postoperatively in 93% of the cases. Eliminating the women practicing contraception, those on postoperative Danazol therapy for endometriosis, male factors, or other reasons for women or their partners being not at risk, conception has occurred 21 times among 20 of 42 patients at risk. Many of the women were referral cases who had had unsuccessful microsurgery or were rejected for microsurgery by their physicians due to extensive disease. These results indicate that the carbon dioxide surgical laser may be a useful adjunct in reconstructive microsurgery for fertility dysfunction.

Endoscopic management of subglottic stenosis with the CO2 surgical laser.

Recent advances in microsurgery of the larynx have heralded a new era in the endoscopic management of subglottic stenosis. The carbon-dioxide laser with bronchoscopic adapters can be successfully employed to reestablish an adequate subglottic lumen. Thirteen cases of subglottic stenosis were managed endoscopically with the carbon dioxide surgical laser. In 77% (10 of 13) of these patients, a satisfactory airway was reestablished within a one-year period. The technique of laser vaporization and the results of treatment are presented. The role of corticosteroid therapy, antibiotic therapy, tracheotomy, dilation, and laryngeal stenting is discussed.

Treatment of subglottic hemangioma with the carbon dioxide laser

Congenital subglottic hemangioma is a potentially life-threatening lesion usually presenting in the first three months of life. Over the years, multiple treatment modalities have been advocated. However, none has been uniformly successful, and morbidity and mortality remain high. With the advent of the carbon dioxide surgical laser, it soon became apparent that this was an ideal tool for the pediatric larynx. The already documented properties of the laser have led to the application of this form of tissue destruction in 11 patients with subglotic hemangioma. This modality has proven to be a safe, effective and rapid means of treating this troublesome lesion.

The use of the carbon dioxide surgical laser for the treatment of verrucae.

The use of the carbon dioxide surgical laser for the treatment of verrucae.

Dose-response Characteristics of the human larynx with carbon dioxide laser radiation

The carbon dioxide surgical laser has become increasingly valuable in the management of various aerodigestive, gynecologic, and dermatologic problems. The histopathologic effects of laser radiation on human tissue have received only minimal attention, however. In an attempt to more precisely define the dose-response characteristics of the normal human vocal cord to carbon dioxide laser radiation, a normal larynx was exposed to varying intensities of laser radiation in situ and studied histologically. Tissue destruction varies with alterations in wattage and time exposure. The biologic effects of laser radioation are reviewed.