[Bone ablation using ultrashort laser pulses. A new technique for middle ear surgery].
OBJECTIVE
Laser applications within the tympanic cavity area are widely accepted. Commonly used systems are CO(2), argon, KTP and erbium devices. The disadvantages are heat development and/or acoustic load of the inner ear. A new laser with ultra short pulses was examined concerning its ablation characteristics and tested for possible applications in the tympanic cavity.


METHODS
Investigations on human ossicles and porcine compacta were performed with a femtosecond laser in order to determine the ablation parameters. This included measurements of the dependency of the threshold energy on the pulse duration and the determination of the ablation ratio using different pulse energy levels. On the basis of histological slices the thermal damages of the bone were examined. Additionally, the processed samples were analyzed with an optical microscope and with a scanning electron microscope in order to evaluate the quality of the perforations.


RESULTS
The measurements showed that the threshold energy has a lower level than the threshold energy of the conventional laser systems. At a pulse duration of 180 fs the smallest fluence, with which an erosion can be achieved, is below 1 J/cm(2). With increasing pulse duration the necessary threshold energy also rises. Due to the low energy level necessary for ablation and the extremely short pulse duration, less thermal damage is induced to the surrounding bone tissue as compared to conventional laser systems. The analysis of the scanning electron microscope demonstrates the extreme precision of this laser system. The achieved accuracy of the incisions and drillings ranges in the microm-area.


CONCLUSIONS
The fs laser represents a new surgical tool for middle ear surgery. It works efficiently and in a touch-free procedure. Due to its high precision and the reduced side effects an advantage in the handling of bony structures is to be expected in relation to other laser systems. Apart from the perforation of the stapes footplate, in particular the handling and modelling of the incus, a further field of applications includes enhanced coupling, e. g. for implantable hearing aids and ossicular chain replacement prosthesis.
Schwab
B
B
HNO-Klinik der Medizinischen Hochschule Hannover. schwab.burkard@mh-hannover.de
Hagner
D
D
Müller
W
W
Lubatschowski
H
H
Lenarz
Th
T
Heermann
R
R
D000818:Animals; D001842:Bone and Bones / Q000473:pathology / Q000601:surgery*; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery; D004429:Ear Ossicles / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D007188:Incus / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy / Q000295:instrumentation*; D008855:Microscopy, Electron, Scanning; D013201:Stapes Surgery / Q000295:instrumentation*; D013552:Swine; D013673:Technology Assessment, Biomedical; D013696:Temperature