A 2-microm continuous-wave laser system for safe and high-precision dissection during NOTES procedures.
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.
Dray
Xavier
X
Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Donatelli
Gianfranco
G
Krishnamurty
Devi Mukkai
DM
Dubcenco
Elena
E
Wroblewski
Ronald J
RJ
Assumpcao
Lia
L
Giday
Samuel A
SA
Buscaglia
Jonathan M
JM
Shin
Eun J
EJ
Magno
Priscilla
P
Pipitone
Laurie J
LJ
Marohn
Michael R
MR
Kantsevoy
Sergey V
SV
Kalloo
Anthony N
AN
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
D013932:Thulium