RESUMEN
Electrosurgical and ultrasonic devices are used in surgical procedures for hemostatic sealing and bisection of vascular tissues. Previous benchtop studies alternatively demonstrated successful infrared laser sealing and cutting of blood vessels, in a sequential, two-step approach. This study describes a smaller, laparoscopic device compatible design, and simultaneous approach to sealing and bisection of vessels, with potential optical feedback. A 1470-nm infrared diode laser sealed and bisected 40 porcine renal arteries, ex vivo. A reciprocating, side-firing, optical fiber, housed in a transparent square quartz optical chamber (2.7 × 2.7 × 25 mm outer dimensions), delivered laser energy over an 11 mm scan length, with a range of incident powers (41-59 W) and treatment times (5-21 s). Vessel diameters ranged from 2.5 to 4.8 mm. Vessel burst pressure measurements were performed on each cut end (n = 80) with success indicated by pressures exceeding 360 mmHg. All vessel ends were successfully sealed and bisected (80/80). The highest incident power, 59 W, yielded short treatment times of 5-6 s. Peak temperatures on the external chamber surface reached 103 oC. Time to cool down to body temperature measured 37 s. Infrared lasers simultaneously seal and bisect blood vessels, with treatment times comparable to, and temperatures and cooling times lower than reported for conventional devices. Future work will focus on integrating the fiber and chamber into a standard 5-mm-outer-diameter laparoscopic device. Customization of fiber scan length to match vessel size may also reduce laser energy deposition, enabling lower peak temperatures, treatment times, and cooling times.
Asunto(s)
Láseres de Semiconductores , Arteria Renal , Animales , Láseres de Semiconductores/uso terapéutico , Porcinos , Arteria Renal/cirugía , Rayos Infrarrojos , Hemostasis Quirúrgica/instrumentación , Hemostasis Quirúrgica/métodos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Laparoscopía/métodos , Laparoscopía/instrumentaciónRESUMEN
INTRODUCTION: Infrared (IR) lasers are being tested as an alternative to radiofrequency (RF) and ultrasonic (US) surgical devices for hemostatic sealing of vascular tissues. In previous studies, a side-firing optical fiber with elliptical IR beam output was reciprocated, producing a linear IR laser beam pattern for uniform sealing of blood vessels. Technical challenges include limited field-of-view of vessel position within the metallic device jaws, and matching fiber scan length to variable vessel sizes. A transparent jaw may improve visibility and enable custom treatment. METHODS: Quartz and sapphire square optical chambers (2.7 × 2.7 × 25 [mm3 ] outer dimensions) were tested, capable of fitting into a 5-mm-OD laparoscopic device. A 1470 nm laser was used for optical transmission studies. Razor blade scans and an IR beam profiler acquired fiber (550-µm-core/0.22NA) output beam profiles. Thermocouples recorded peak temperatures and cooling times on internal and external chamber surfaces. Optical fibers with angle polished distal tips delivered 94% of light at a 90° angle. Porcine renal arteries with diameters of 3.4 ± 0.7 mm (n = 13) for quartz and 3.2 ± 0.7 mm (n = 14) for sapphire chambers (p > 0.05), were sealed using 30 W for 5 s. RESULTS: Reflection losses at material/air interfaces were 3.3% and 7.4% for quartz and sapphire. Peak temperatures on the external chamber surface averaged 74 ± 8°C and 73 ± 10°C (p > 0.05). Times to cool down to 37°C measured 13 ± 4 s and 27 ± 7 s (p < 0.05). Vessel burst pressures (BP) averaged 883 ± 393 mmHg and 412 ± 330 mmHg (p < 0.05). For quartz, 13/13 (100%) vessels were sealed (BP > 360 mmHg), versus 9/14 (64%) for sapphire. Computer simulations for the quartz chamber yielded peak temperatures (78°C) and cooling times (16 s) similar to experiments. CONCLUSIONS: Quartz is an inexpensive material for use in a laparoscopic device jaw, providing more consistent vessel seals and faster cooling times than sapphire and current RF and US devices.
Asunto(s)
Laparoscopía , Fibras Ópticas , Porcinos , Animales , Cuarzo , Óxido de Aluminio , Rayos LáserRESUMEN
This study explores UV light induced fluorescence from blood vessels for indicating successful infrared laser sealing of vascular tissues. A light emitting diode (LED) with center wavelength of 340 nm and 0.1 mW power was used with a Y-shaped fiber bundle of seven 200-µm-core fibers. The central excitation fiber was connected to the LED, while the detection ring of six fibers was connected to a spectrometer. The fiber bundle was aligned with porcine renal arteries compressed between optical windows. Fluorescence was acquired before and after vessel sealing, with a 1470 nm laser for 5 s at 30 W (sealing, n = 10) or 5 W (control, n = 10). Signal increase in the 470-520 nm spectrum was correlated with vessel burst pressures (BP). Integrated fluorescence increased 71 ± 25% at 30 W vs. 19 ± 14% at 5 W (p < 0.05), corresponding to a successful BP of 639 ± 189 mmHg vs. failed seal BP of 39 ± 41 mmHg (p < 0.05). Real-time measurements showed a gradual increase in fluorescence with the signal reaching a plateau at 3-4 s, indicating that shorter seal times are possible. The increase in fluorescence signal during laser vessel sealing may provide a non-destructive, real-time, optical method for indicating hemostatic seals.