Surgical utility of a new carbon dioxide laser fiber: functional and histological study.
OBJECTIVE
The objective was to investigate the functional and histological properties of surgical procedures using a new carbon dioxide (CO2) laser fiber.


METHODS
In vitro and in vivo animal models.


METHODS
In vitro experiments using porcine true vocal cord and arytenoid cartilage were designed to study the histological effects of using a photonic band-gap fiber assembly for CO2 laser energy delivery. Continuous and pulsed-wave settings at different wattages were tested. In vivo endoscopic surgery on canine larynges and buccal mucosa were performed to examine functional and short-term healing when performing photonic band-gap fiber assembly-assisted laser surgery.


RESULTS
In vitro experiments showed consistent cutting with the photonic band-gap fiber assembly using either straight or 90 degrees bent-tip fibers. The surrounding tissue in these experiments showed little collateral thermal damage with the average range of thermal width from 14.1 to 18.8 microm in vocal cords and from 5.2 to 10.5 microm in cartilage. Similarly, thermal depth ranged from 28.0 to 350.0 microm in vocal cords and from 269.7 to 739.6 microm in cartilage. In vivo experiments demonstrated ease in maneuvering and flexibility for cutting. There was minimal blood loss, smoke plume, or carbonaceous debris. There were no postprocedural complications. Normal oral intake was noted on postprocedural day 1. There was no evidence of stridor or respiratory distress. Seven days after the procedure, re-epithelialization was complete in the buccal incisions and nearly completed in the laryngeal incisions.


CONCLUSIONS
The photonic band-gap fiber assembly produced reliable results in cutting with functional characteristics representing an improvement over current technology. The device shows promise as an effective tool for minimally invasive procedures that are amenable to use of the CO2 laser.
Devaiah
Anand K
AK
Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, 88 East Newton, D608 Colamore, Boston, MA 12118, U.S.A. anand.devaiah@BMC.org
Shapshay
Stanley M
SM
Desai
Urman
U
Shapira
Gil
G
Weisberg
Ori
O
Torres
David S
DS
Wang
Zhi
Z
D000818:Animals; D001707:Biopsy, Needle; D002245:Carbon Dioxide; D004285:Dogs; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D023421:Models, Animal; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D013552:Swine; D013718:Tensile Strength; D046509:Tissue Culture Techniques; D014826:Vocal Cord Paralysis / Q000473:pathology / Q000601:surgery; D014827:Vocal Cords / Q000473:pathology* / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology*
D002245:Carbon Dioxide