Submucosal Laser Research Articles

Comparative analysis of hemorrhoid treatment by submucosal laser hemorrhoidoplasty with Doppler controlled dezarterization and mucopexy and hemorrhoidectomy with ultrasound scalpel

Comparative analysis of hemorrhoid treatment by submucosal laser hemorrhoidoplasty with Doppler controlled dezarterization and mucopexy and hemorrhoidectomy with ultrasound scalpel

RESULTS OF TREATMENT OF HEMORRHOIDS BY SUBMUCOSAL W-LASER DESTRUCTION OF HEMORRHOIDAL PILES

AIM: to evaluate the results of submucosal laser destruction of hemorrhoids using a W-laser.PATIENTS AND METHODS: one-hundred twenty-four patients with chronic hemorrhoids underwent submucosal W-laser destruction of hemorrhoidal piles in September 2017 – January 2019.RESULTS: the time of the procedure was 18-22 minutes. The hospital stay was 7-10 hours. The maximal edema of the pararectal area appeared by the 3rd days and was resolved on 13-14 days. The size of the edema depended on the volume of anesthetic. Maximal pain was observed on days 1 and 3 after surgery. The period for taking analgesics was not more than 7 days. No prolapse of hemorrhoidal piles was detected in all patients after 4 weeks postoperatively. No rectal bleeding was detected in 97.3%. The excellent result of treatment was found in 70.2%, good – in 22.6%, bad – in 7.2%.CONCLUSION: submucosal W-laser destruction of hemorrhoidal piles showed a less pain intensity after surgery and a decrease in the complication rate, fast recovery and better quality of life.

Analysis of surgical treatment results of patients with chronic rhinitis

Introduction.Chronic nasal congestion caused by edema of inferior turbinate affect 20% of population and strongly influences their quality of life. Pharmacological treatment of chronic rhinitis is considered to be the first line therapy. However, if conservative treatment is not effective and clinical signs are not disappearing the question about relevant surgical treatment is arising. Nowadays there are many methods of exposure on mucosa of the inferior turbinate. Considering high incidence of the pathology surgical treatment is of current importance in modern otorhinolaryngology.Objective.Assessment of the effectiveness and comparison of the period of rehabilitation after submucosal laser destruction by laser beam with wavelength 1,56 and after submucosal destruction by radiosurgical instruments Ellman Surgitron with a frequency of 4 MHz in patients with chronic rhinitis.Methods.60 patients were included into the study aged from 18 to 80 years old with chronic rhinitis. All the patients were admitted to the department to perform surgical treatment. Semiconducted laser with wavelength 1,56 and radiosurgical instrument Ellman Surgitron with frequency of 4 MHz were applied to the treatment. We assessed SNOT20 score, endoscopic features, anterior active rhinomanometry and saccharin test results in all patients following the surgery.Conclusions.The data we have obtained provide the basis for choosing semiconductor laser as more effective and safe technique for the treatment of patients with chronic rhinitis.

Submucosal laser ablation of internal hemorrhoids

To analyze efficacy and safety of submucosal laser ablation of internal hemorrhoids (SLT). Systematic review included 10 articles published in electronic databases PubMed, Cochrane Library, Elibrary until January 2019. There were only full-text publications from prospective clinical trials devoted to submucosal laser ablation in the treatment of hemorrhoids. Isolated SLT was used in 4 trials, combination with other minimally invasive procedures was reported in 6 reports. SLT was predominantly used in the treatment of hemorrhoids grade 2-3. Efficacy of procedure was 91.1-100% after 6 months and 87.5-100% after 12 months. Intra- and postoperative complications included intraoperative bleeding (8.4%), perianal and external piles edema (8.2%), postoperative bleeding (2.7%), urinary retention (1.2%), anal fistula (0.6%), perianal abscess (0.14%). Submucosal laser ablation is quite effective and safe option for treatment of hemorrhoids grade 2-3. However, further researches are required considering the absence of clear recommendations on laser beam parameters, indications for procedure and data on long-term outcomes.

Rhinitis medicamentosa

One type of non-allergic non-infectious rhinitis is represented by a heterogeneous group of rhinitis medicamentosa, which can be divided into several pathogenetic types. The most common rebound nasal congestion associated with the use of topical decongestants. Excessive use of intranasal decongestants leads to a decrease in the number of alpha-adrenoreceptors on the surface of cell membranes and uncoupling their connection with the G-protein and the development of tachyphylaxis. To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs. However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days. Rhinitis associated with local inflammation is caused by the intake of acetylsalicylic acid (ASA) or other non-steroidal anti-inflammatory drugs. Currently, the so-called "aspirin triad" is well known - a combination of bronchial asthma, rhinosinusitis (often polyposis) and intolerance to ASA. Neurogenic rhinitis develops due to the use of drugs that violate vascular tone, for example, antihypertensive drugs or type 5 phosphodiesterase inhibitors. Drug-induced rhinitis has a significant impact on the patient's quality of life: nasal congestion, rhinorrhea, secondary night apnea, insomnia as a result of nasal breathing disturbances, headaches, irritability, weakness after sleepless nights disturb patients to a large extent. Timely diagnosis and withdrawal of a provocative drug, the use of topical corticosteroids in case of severe rhinitis are the basis of the treatment of rhinitis medicamentosa. In severe cases, there is a need, including surgical treatment, such as, for example, submucosal laser destruction of the lower nasal concha.

1131-P: Endoscopic Duodenal Submucosal Laser Ablation for the Treatment of Type 2 Diabetes Mellitus: Results of First-in-Human Pilot Study

The duodenum has recently emerged as a key regulator in glucose metabolism via modulation of a complex network of neural and hormonal signals in response to ingested food. DiaGone™ is an endoscopic device which utilizes precisely controlled laser technology to target the duodenal submucosal neural plexi with the aim of improving glucose control by modulating the gastrointestinal neurohumoral axis. Nine subjects (5 males) with obesity (BMI 34.0 ± 4.6 kg/m2) and type 2 diabetes mellitus (T2DM) insufficiently controlled on metformin were included in this first-in-human trial in order to assess the efficacy and safety of DiaGone™. Subjects were instructed to continue with regular diet 24h after the procedure and metformin dose was not changed during the study period. Biochemical and anthropometric parameters were assessed at baseline and 3 and 6 months after the procedure and continuous glucose monitoring (CGM) and a standard liquid meal test were performed at baseline and 3 months after the procedure. DiaGone™ significantly decreased HbA1C from 78.3 ± 13.3 mmol/mol at baseline to 64.9 ± 6.4 mmol/mol and 64.8 ± 7.1 mmol/mol at 3 and 6 months, respectively (p<0.01). Similarly, a decrease in fasting glucose levels was noted (12.4 ± 3.5 vs. 9.5 ± 2.0 vs. 9.7 ± 2.7 mmol/l, p<0.01) with no significant changes in fasting insulin levels. Glucose AUC during the 150 min meal test 3 months after the procedure showed a reduction of 20% from baseline (43,435 vs. 34,096, p<0.01). No significant changes were observed in AUC for insulin. No adverse events related to the procedure or significant changes in weight were reported throughout the 6-month period. In conclusion, these pilot results suggest that endoscopic duodenal submucosal laser ablation using the DiaGone™ device is associated with improvements in both baseline and postprandial glycemia as well as HbA1C with no significant changes in insulin levels or body weight while having a favorable safety and tolerability profile. Disclosure M. Mraz: None. I. Marcovitch: Employee; Self; Digma Medical. I. Lankova: None. H. Kratochvilova: None. A. Cinkajzlova: None. M. Benes: None. J. Korner: Board Member; Self; Digma Medical. Stock/Shareholder; Self; Digma Medical. Z. Vlasakova: None. J. Spicak: None. T. Pelikanova: None. M. Haluzik: None. Funding MH CZ - DRO; Institute for Clinical and Experimental Medicine (IN00023001); RVO (VFN64165)

Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)

Recently, endoscopic submucosal dissection (ESD) has been performed to treat early gastric cancer. The en bloc resection rate of ESD has been reported to be higher than that of conventional endoscopic mucosal resection (EMR), and ESD can resect larger lesions than EMR. However, ESD displays a higher complication rate than conventional EMR. Therefore, the development of devices that would increase the safety of ESD is desired. Lasers have been extensively studied as a possible alternative to electrosurgical tools. However, laser by itself easily resulted in perforation upon irradiation of the gastrointestinal tract. We hypothesized that performing ESD using a CO2 laser with a submucosal laser absorber could be a safe and simple treatment for early gastric cancer. To provide proof of concept regarding the feasibility of ESD using a CO2 laser with submucosally injected laser absorber solution, an experimental study in ex vivo and in vivo porcine models was performed. Five endoscopic experimental procedures using a carbon dioxide (CO2) laser were performed in a resected porcine stomach. In addition, three endoscopic experimental procedures using a CO2 laser were performed in living pigs. In the ex vivo study, en bloc resections were all achieved without perforation and muscular damage. In addition, histological evaluations could be performed in all of the resected specimens. In the in vivo study, en bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures. Endoscopic submucosal dissection using a CO2 laser with a submucosal laser absorber is a feasible and safe method for the treatment of early gastric cancer.

両側輪状披裂関節強直症に対するレーザー破裂軟骨切除術

CO2 laser arytenoidectomy was performed for bilateral median vocal fold fixation caused by cricoarytenoid joint ankylosis. Submucosal laser arytenoidectomy was performed, and the wound was covered by the mucosa with fibrin glue. The patient did not complain of dyspnea and could eat normal food without aspiration two days after surgery. Voice quality after surgery was as good as before surgery.CO2 laser arytenoidectomy is a useful surgical procedure not only for bilateral vocal fold paralysis but also for bilateral cricoarytenoid joint ankylosis.