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Ex vivo and animal study of the blue diode laser, Tm fiber laser, and their combination for laparoscopic partial nephrectomy

DOI:10.1002/lsm.23158 期刊:Lasers in Surgery and Medicine 出版年份:2019 更新时间:2025-09-19 17:13:59
摘要: Background and Objectives: To evaluate the feasibility of using a novel blue diode laser (blue laser), a thulium fiber laser (Tm laser), and their combination as a directed‐energy surgical tool in laparoscopic partial nephrectomy (LPN). Study Design/Materials and Methods: The blue laser emitting at 442 nm, the Tm laser emitting at 1,940 nm wavelengths, and the combination of them were tested. First, cutting and coagulative abilities of the lasers were characterized ex vivo on porcine kidney in air and CO2. Histological staining was performed to assess the efficiency of ablation and coagulation. Next, experimental LPN was performed on a porcine model at zero ischemia. Upper and lower segments of both kidneys were resected. Total operation time and resection time were measured; bleeding and carbonization were evaluated. Results: Ex vivo data show that laser‐induced ablation and coagulation processes do not differ substantially between CO2 and air environments. Histological analysis of ex vivo incisions demonstrates that the blue laser produced deep ablation with relatively narrow coagulation zone, whereas Tm laser was less efficient in terms of ablation but possessed excellent coagulative properties. Experimental LPN revealed that the blue laser provided fast cutting with minimal carbonization, whereas Tm laser induced slow cutting with strong carbonization. The combination of the blue and Tm lasers provided the most promising results demonstrating the highest resection rate, almost carbonization free resection surface and clinically acceptable hemostasis enabling LPN without the need for vessel clamping. Conclusions: The blue laser can be efficiently utilized in LPN. Furthermore, the combination of the blue and Tm lasers into a single modality may be beneficial for further development of successful laser‐assisted LPN.
作者: Mikhail Enikeev,Ekaterina Laukhtina,Alexander Kurkov,Valeriya Arkhipova,Viktoriya Andreeva,Ilya Yaroslavsky,Gregory Altschuler
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To evaluate the feasibility of using a novel blue diode laser, a thulium fiber laser, and their combination as a directed‐energy surgical tool in laparoscopic partial nephrectomy (LPN).

The blue diode laser and the combination of blue and thulium fiber lasers present a novel and efficient alternative for laparoscopic partial nephrectomy, offering fast cutting with minimal carbonization and acceptable hemostasis. The dual laser system shows promise for reducing operation time and improving surgical outcomes.

The study was limited by a small sample size for in vivo LPN (one resection per laser/laser combination), subjective estimation of blood loss, and lack of follow-up on the healing process. The surgeon's experience may have influenced the outcomes.

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