Article
Laser application for non-destructive blood vessel haemostasis on brain tissue as an alternative to bipolar forceps
Laserapplikation zur Hämostase von zerebralen Blutgefäßen als gewebeschonende Alternative zur bipolaren Pinzette
Search Medline for
Authors
-
Alessa Hutfilz
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Deutschland
-
Dirk Theisen-Kunde
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Deutschland
-
Mario Matteo Bonsanto
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Lübeck, Deutschland
-
Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Deutschland; Universität zu Lübeck, Institut für Biomedizinische Optik, Lübeck, Deutschland
| Published: | May 25, 2022 |
|---|
Outline
Text
Objective: Due to high water absorption in the infrared spectrum, lasers around 2 µm wavelength can be useful in neurosurgery for tissue coagulation. Particularly the thulium laser emitting at 1940nm shows a high ablation efficiency and proves to be suitable for tumour coagulation [1]. Bipolar forceps are commonly used for intraoperative haemostasis in neurosurgery, which can cause mechanical tissue damage, while thulium laser can provide a tissue gentle haemostasis through non-contact coagulation. Aim of this study is a non-destructive blood vessel coagulation by pulsed thulium laser.
Methods: Blood vessels on ex-vivo porcine brain tissue (Figure 1A [Fig. 1]) were treated in non-contact with a thulium laser in pulsed mode (100 to 500 ms pulse width, 1 Hz repetition rate, 1940 nm wavelength, 1.5 to 7.5 J pulse energy/Asclepion Laser Technologies GmbH, Jena, Germany) with CO2-cooling as shown in Figure 1B and for comparison with bipolar forceps (60 W power, VIO 300 D, Erbe Elektromedizin GmbH, Tübingen, Germany). Tissue trauma and destruction depth were evaluated by white light images and OCT-B-Scans (1060 nm wavelength, Thorlabs GmbH, Dachau, Deutschland). OCT enabled the assessment whether laser irradiation could achieve blood vessel occlusion (Figure 1C [Fig. 1]).
Results: Pulsed laser application for 3 s achieved a blood vessel occlusion rate of 92% at low pulse energy of 1,5 J with circular tissue trauma of 2.1 ± 1 mm radius. With increasing laser pulse duration (500 ms) the tissue trauma increased. Bipolar forceps showed an occlusion rate of 100 %. Destruction depth by laser application is limited to 40 μm and is thus a factor of 10 less traumatizing than with bipolar forceps.
Conclusion: Pulsed thulium laser at 1940 nm with CO2 cooling achieved non-destructive blood vessel haemostasis and has proven to be a tissue-gentle method compared to bipolar forceps. Future plans include integrating the flexible laser fibre (0,7mm in diameter) into an intraoperative ultrasound aspirator system for intraoperative direct coagulation of bleeding during ultrasound aspirator without interrupting the intraoperative workflow.
Figure 2 [Fig. 2]
References
- 1.
- Passacantilli E, Anichini G, Lapadula G, Salvati M, Lenzi J, Santoro A. Assessment of the utility of the 2-µ thulium laser in surgical removal of intracranial meningiomas. Lasers Surg Med. 2013 Mar;45(3):148-54.
