Thermal Injury Zones Research Articles

MR imaging of Ho:YAG laser diskectomy with histologic correlation.

Twelve cadaveric vertebral specimens were imaged after holmium yttrium aluminum garnet (Ho:YAG) laser diskectomy to determine the usefulness of magnetic resonance (MR) imaging in evaluating treatment outcome. The Ho:YAG laser was operated at 1.0-2.0 J per pulse, 5 Hz, and 250-microseconds pulse width. The total energy varied between 600 and 2,700 J. Two distinct patterns emerged on MR images. Tissue ablation at higher power (1.5 and 2.0 J per pulse) produced discrete signal voids that correlated with areas of laser-induced ablation identified at gross inspection. More subtle changes, characterized by a high-signal-intensity ring, were seen in the specimens lased at 1.0 J per pulse. The latter appearance corresponded to incomplete vaporization of diskal tissue, a broader zone of minimal thermal injury, and sparing of adjacent vertebral endplates. Total mass loss did not appear to be affected by the choice of power setting (1.0 vs 1.5 J per pulse), with total laser energy held constant.

Comparison of thermal injury zones in loop electrical and lasercervical excisional conization

Thirty cervical conization specimens obtained by thin-loop electric excision were compared with 30 carbon dioxide laser excisional cone specimens. Zones of thermal artifact were measured with a precise stage micrometer technique calibrated to a Zeiss standard. The mean depth of coagulation at the ectocervical margin measured 0.187 and 0.164 mm for thin loop and laser, respectively. Thermal artifact at the endocervical margin was greater with electric loop (0.295 mm) than with superpulsed carbon dioxide laser (0.137 mm). The zones of thermal injury induced by both electric loop and laser made no significant impact on the interpretation of margin adequacy.

Bone ablation with Er:YAG and CO2 laser: study of thermal and acoustic effects.

A pulsed Er:YAG laser at 2.94 microns and a superpulsed CO2 laser at 10.6 microns are used to investigate bone ablation applications in otolaryngology. Quantitative measurements of mass removal and the ablation depth of cat skull bone and rat femur are presented with the Er:YAG laser at fluences of 9-117 J/cm2. Histological results show that the minimal thermal injury zone from the edge of the lesion is 5-10 microns. Comparison of the photoacoustic and thermal effects during the ablation process indicates that the temperature rise from the 10.6-microns light was higher than that from the 2.94-microns light but that the photoacoustic wave amplitude produced with the Er:YAG laser was higher than that with the CO2 laser. The fluence used for the efficient ablation of bone tissues produces a photoacoustic wave ranging from 100 to 120 dB. The ear can tolerate this level for a short time period. Results of this study suggest that the Er:YAG laser can be an important surgical tool in otolaryngology.

Ablation of bone and methacrylate by a prototype mid-infrared erbium:YAG laser.

An erbium:YAG laser was used to generate 200-microseconds pulses of mid-infrared 2.94-microns light in both the single and multimode configurations. Laser pulses were focused on the surfaces of both rabbit long bones and methacrylate blocks, and the tissue response was examined histologically. The depth of thermal injury was determined by ocular micrometry. Over all energy levels tested, the erbium:YAG laser produced ablation of bone and methacrylate with minimal thermal damage to adjacent tissue. Increasing the laser energy per pulse produced increasingly wider and deeper grooves in both bone and methacrylate. However, such increase in laser energy produced a proportionately greater increase in the zone of thermal injury in methacrylate as compared with bone. These studies suggest the feasibility of a surgical erbium:YAG laser in orthopaedics and other forms of ablative surgery.

Use of the CO2 Laser in Urology

The CO2 laser emits coherent light in the far infrared region with an extremely short extinction length. Energy absorption at the impact site is very intense and results in a surgical incision characterized by a zone of vaporization surrounded by a narrow zone of thermal necrosis and sublethal thermal injury. Infected epithelium can be ablated precisely to a shallow depth so that the papillomavirus is killed and rapid healing can occur. The CO2 laser is the treatment of choice for condylomata acuminata that are extensive or recurrent, are within the urethral meatus, or occur during pregnancy, a period during which cytotoxic drugs are contraindicated. With this technique virtually all patients with condylomata acuminata can be cured rapidly with minimal morbidity, complications, or risk of recurrence.

Laser ablation of human atherosclerotic plaque without adjacent tissue injury

Seventy samples of human cadaver atherosclerotic aorta were irradiated in vitro using a 308 nm xenon chloride excimer laser. Energy per pulse, pulse duration and frequency were varied. For comparison, 60 segments were also irradiated with an argon ion and an Nd:YAG (neodymium:yttrium aluminum garnet) laser operated in the continuous mode. Tissue was fixed in formalin, sectioned and examined microscopically. The Nd:YAG and argon ion-irradiated tissue exhibited a central crater with irregular edges and concentric zones of thermal and blast injury. In contrast, the excimer laser-irradiated tissue had narrow deep incisions with minimal or no thermal injury. These preliminary experiments indicate that the excimer laser vaporizes tissue in a manner different from that of the continuous wave Nd:YAG or argon ion laser. The sharp incision margins and minimal damage to adjacent normal tissue suggest that the excimer laser is more desirable for general surgical and intravascular uses than are the conventionally used medical lasers.

Effects of carbon dioxide, Nd-YAG, and argon laser radiation on coronary atheromatous plaques

Laser radiation has been successfully applied in several areas of medical practice. However, its use in cardiology and specifically its effects on obstructive atherosclerosis have largely been unexplored. To evaluate effects of laser radiation on atherosclerotic plaques 25 fresh necropsy atherosclerotic coronary artery segments were exposed to laser radiation with either a carbon dioxide, Nd-YAG, or argon laser. Split or intact segments were prepared under dry conditions or while immersed in saline solution or blood and exposed to laser radiation as power and duration of exposure varied. All 3 lasers were capable of creating controlled injury to atherosclerotic plaques. In general, the magnitude of injury varied according to the total energy delivered (that is, power times duration of exposure). Calcified and noncalcified plaques were penetrated with similar levels of injury. Histologic examination demonstrated that laser radiation produced a wedge incision in the atherosclerotic plaque which was surrounded by zones of thermal and acoustic injury.