title: A 2-microm continuous-wave laser system for safe and high-precision dissection during NOTES procedures.
abstract: BACKGROUND
  Lasers 2-microm in wavelength offer efficient tissue cutting with limited thermal damage in biological tissue.
  
  
  OBJECTIVE
  To evaluate the dissection capabilities of a 2-microm continuous-wave laser for NOTES procedures.
  
  
  METHODS
  We conducted 18 acute animal experiments. Group 1 (three animals): transcolonic access to the peritoneal cavity (15-W transcolonic laser puncture, balloon dilation over the laser probe). Group 2 (six animals): transcolonic access with needle-knife puncture and balloon dilation. Group 3 (three animals): transgastric access to the peritoneal cavity (similar technique as group 1) followed by laser-assisted dissection of the kidney. In one animal of group 3, a therapeutic target (hematoma) was created by percutaneous puncture of the kidney. Group 4 (six animals): transgastric access (similar to the technique of group 2).
  
  
  RESULTS
  Translumenal access to the peritoneal cavity was achieved in 2-3 min in group 1 (significantly shorter than with the needle-knife-assisted technique, 4-5 min, p=0.02) and in 7-10 min in group 3 (compared to 6-17 min in group 4, p=0.88). In group 3, laser dissection of the parietal peritoneum and of perinephric connective tissue allowed access to the retroperitoneum with complete removal of a blood collection in the animal with puncture trauma. Laser dissection demonstrated good maneuverability, clean and rapid cutting, and excellent hemostasis. Peritoneoscopy and necropsy showed no damage of targeted tissue and surrounding organs.
  
  
  CONCLUSIONS
  The 2-microm continuous-wave laser system showed promising capabilities for highly precise and safe dissection during NOTES procedures.
authors: Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors: Xavier
authors: X
authors: Dray
authors: Gianfranco
authors: G
authors: Donatelli
authors: Devi Mukkai
authors: DM
authors: Krishnamurty
authors: Elena
authors: E
authors: Dubcenco
authors: Ronald J
authors: RJ
authors: Wroblewski
authors: Lia
authors: L
authors: Assumpcao
authors: Samuel A
authors: SA
authors: Giday
authors: Jonathan M
authors: JM
authors: Buscaglia
authors: Eun J
authors: EJ
authors: Shin
authors: Priscilla
authors: P
authors: Magno
authors: Laurie J
authors: LJ
authors: Pipitone
authors: Michael R
authors: MR
authors: Marohn
authors: Sergey V
authors: SV
authors: Kantsevoy
authors: Anthony N
authors: AN
authors: Kalloo
mesh_terms: D000818:Animals; D002404:Catheterization; D003106:Colon / Q000601:surgery; D004195:Disease Models, Animal; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006406:Hematoma / Q000601:surgery; D006489:Hemostatic Techniques / Q000295:instrumentation; D007668:Kidney / Q000601:surgery; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects; D007834:Lasers; D010529:Peritoneal Cavity / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial; D013270:Stomach / Q000601:surgery; D034421:Sus scrofa; D013932:Thulium
chemical_list: D013932:Thulium