title: Reduction of thermocoagulative injury via use of a picosecond infrared laser (PIRL) in laryngeal tissues.
abstract: The carbon dioxide (CO2) laser is routinely used in glottic microsurgery for the treatment of benign and malignant disease, despite significant collateral thermal damage secondary to photothermal vaporization without thermal confinement. Subsequent tissue response to thermal injury involves excess collagen deposition resulting in scarring and functional impairment. To minimize collateral thermal injury, short-pulse laser systems such as the microsecond pulsed erbium:yttrium-aluminium-garnet (Er:YAG) laser and picosecond infrared laser (PIRL) have been developed. This study compares incisions made in ex vivo human laryngeal tissues by CO2 and Er:YAG lasers versus PIRL using light microscopy, environmental scanning electron microscopy (ESEM), and infrared thermography (IRT). In comparison to the CO2 and Er:YAG lasers, PIRL incisions showed significantly decreased mean epithelial (59.70 µm) and subepithelial (22.15 µm) damage zones (p < 0.05). Cutting gaps were significantly narrower for PIRL (133.70 µm) compared to Er:YAG and CO2 lasers (p < 0.05), which were more than 5 times larger. ESEM revealed intact collagen fibers along PIRL cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 and Er:YAG laser incisions. IRT demonstrated median temperature rise of 4.1 K in PIRL vocal fold incisions, significantly less than for Er:YAG laser cuts (171.85 K; p < 0.001). This study has shown increased cutting precision and reduced lateral thermal damage zones for PIRL ablation in comparison to conventional CO2 and Er:YAG lasers in human glottis and supraglottic tissues.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. arne.boettcher@charite.de.|Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. arne.boettcher@charite.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Böttcher
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Kucher
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Jowett
authors.affiliation: Atomically Resolved Dynamics Division, Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Krötz
authors.affiliation: Leibniz Institute for Experimental Virology, Heinrich Pette Institute, University of Hamburg, Hamburg, Germany.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Reimer
authors.affiliation: Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Schumacher
authors.affiliation: Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Anders
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Münscher
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Carsten V
authors.initials: CV
authors.lastname: Dalchow
authors.affiliation: Atomically Resolved Dynamics Division, Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany.
authors.forename: R J Dwayne
authors.initials: RJD
authors.lastname: Miller
mesh_terms: D002102:Cadaver; D002921:Cicatrix / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008855:Microscopy, Electron, Scanning; D008866:Microsurgery / Q000379:methods*; D014827:Vocal Cords / Q000601:surgery* / Q000648:ultrastructure