title: A multi-wavelength fiber-optic temperature-controlled laser soldering system for upper aerodigestive tract reconstruction: an animal model.
abstract: OBJECTIVE
  Laser soldering of a thick multilayer organ using conventional CO(2) lasers is ineffective. The purpose of this work was to develop a method for bonding the multilayer tissue of the upper aerodigestive tracts (UADT) without the need of sutures or stapling.
  
  
  METHODS
  Animal model.
  
  
  METHODS
  Academic research laboratory.
  
  
  METHODS
  The authors developed a multi-wavelength laser system, based on 2 fiber-optic lasers applied simultaneously. A highly absorbable CO(2) laser interacts with the muscular layer, and a nonabsorbable GaAs laser interacts with indocyanine-green solid albumin, placed between the mucosa and the muscular layer. The authors used an ex vivo porcine model to examine the capability of this system to effectively correct esophageal tears.
  
  
  RESULTS
  The soldered esophagi burst pressure was >175 cm H(2)O (98% success rate) in 88 of the 90 experiments. A conventional CO(2) laser soldering resulted in insufficient bonding (mean burst pressure of 40 ± 7 cm H(2)O, n = 5), while the multi-wavelength laser system provided an ~9-fold tighter seal (359 ± 75.4 cm H(2)O, P < .0001, n = 15). Burst pressures after conventional suturing of the defect was significantly lower (106 ± 65.8 cm H(2)O, P < .001) than in the multi-wavelength laser system.
  
  
  CONCLUSIONS
  Bonding of the UADT mucosa using a multi-wavelength, temperature-controlled laser soldering system can support significantly higher pressures then conventional CO(2) laser soldering and suture repair. The mean bonding pressure was 3.5-fold higher than the maximal swallowing pressure. Our findings provide a basis for implementation of new surgical tools for repair of esophageal perforations.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. tamarul@gmail.com
authors.forename: Avraham
authors.initials: A
authors.lastname: Abergel
authors.forename: Ilan
authors.initials: I
authors.lastname: Gabay
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Abraham
authors.initials: A
authors.lastname: Katzir
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004947:Esophagus / Q000293:injuries / Q000601:surgery*; D005336:Fiber Optic Technology / Q000295:instrumentation*; D017075:Laser Coagulation / Q000295:instrumentation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture; D013536:Suture Techniques; D013552:Swine; D013696:Temperature; D016896:Treatment Outcome; D014945:Wound Healing