Soft tissue cutting efficiency by 980 nm laser with carbon-, erbium-, and titanium-doped optothermal fiber converters

Laser-Induced Blood Coagulation for Surgical Application: A Scoping Review

There is a lack of evidence-based reviews on the effects of laser irradiation on blood coagulation in the literature, despite a large number of clinical trials. We therefore evaluated the available evidence on laser irradiation parameters used in coagulation of blood to optimize physical parameters. We performed a literature search for recent scientific studies indexed between 2017 and 2023 using the databases of PubMed and ScienceDirect. Articles were selected based on defined inclusion and exclusion criteria, and 78 publications in total were eventually included in this scoping review. The following were found to produce significant benefits in blood coagulation for surgical application: (1) dentistry and oral surgeries: 980 nm, 27 s, 2 W, 1502.7 W/cm2, 26.5 J, 622 J/cm2, 400 μm; (2) urogenital disorders: 532 nm, 4 s, 40 W, 10600 W/cm2, 1.3 J, 424 J/cm2, 600 μm; (3) ophthalmic disorders: 810 nm, 1 s, 1 W, 3540 W/cm2, 0.75 J, 1326 J/cm2, 100 μm; (4) embryological surgeries: 1064 nm, 10 s, 25 W, 35400 W/cm2, 262.5 J, 371000 J/cm2, 332.5 μm; (5) dermatological disorders: 1064 nm, 20 W, 2440 W/cm2, 0.1 J, 24 J/cm2, 670 μm; (6) gastrointestinal disorders: 532 nm, 3 s, 20 W, 1051 W/cm2, 120 J, 26500 J/cm2, 760 μm; (7) neurological surgeries: 2.5 s, 1.5 W, 1035 W/cm2, 2 J, 1584 J/cm2, 385 μm; (8) pulmonary disorders: 1320 nm, 5s, 35 W, 12450 W/cm2, 250 J, 65000 J/cm2, 700 μm (9) cardiovascular disorders: 1064 nm, 16.5 s, 5 W, 1980.5 W/cm2, 900 J, 760 J/cm2, 400 μm. In conclusion, our scoping review identifies that combining data from all clinically heterogeneous studies suggests that laser irradiation reflects an effective method for inducing blood coagulation in several medical fields.

Evaluation of cutting efficiency and thermal damage during soft tissue surgery with 940 nm-diode laser: An ex vivo study

OBJECTIVES

To investigate quantitatively the cutting efficiency and the thermal effects in the surrounding soft tissues of incisions that are induced by a 940 nm-diode laser with different power settings.

MATERIALS AND METHODS

Fifty-four gingival samples were prepared from the lower jaws of freshly slaughtered German-land race pigs and were randomly divided into 9 groups (n = 6) according to the adjusted output power (1, 1.5, 2, 2.5, 3, 3.5, 4, 5 and 6 W). Five incisions were implemented for each sample using a diode laser (940 nm) in continuous wave with an initiated tip resulting in 30 incisions for each experimental group utilizing a three-dimensional computer-controlled micropositioner. The samples were prepared for histometric evaluation using a transmitted light microscope. The cutting depth and width and the thermal damage were recorded for each sample and the efficiency factor γ was calculated.

RESULTS

The highest cutting efficiency (γ_z  = 0.81 ± 0.03) exhibited the group with 5 W output power (p < 0.05), while the lowest (γ_z  = 0.45 ± 0.11) showed the 1-W group (p < 0.05). Over 3.5 W there was a rapid increase in the size of thermal damage of the incisions, especially for 6 W, which presented the largest.

CONCLUSIONS

The most effective power parameters of diode laser (940 nm) for soft tissue surgery were from 3 to 5 W. The outcomes of the current study may help to establish clinical protocols for the use of diode lasers (940 nm) in soft tissue surgery in contact mode assisting dental professionals to achieve optimal clinical results and avoid complications.

Controlling the Temperature on the Vein Wall Based on the Analysis of the IR Signal during Endovasal Laser Treatment

Possibility of controlling the temperature of the vein wall during endovasal laser treatment (EVLT) is investigated. The desired medical effect is achieved by the coagulation of the vein wall at the temperature of 80 °C. Heating of the vein wall is mainly due to the efficient conversion of laser radiation into heat in an optothermal fiber converter (OTFC) located at the output end of the optical fiber placed inside the vein. Titanium-containing optothermal fiber converter (TOTFC) is very promising for EVLT application due to its high efficiency in converting laser energy into thermal energy and its smooth shape that excludes perforation of the vein wall when the fiber moves inside the vein. During the endovasal laser treatment heated by laser radiation TOTFC emits an IR signal which can be used for controlling the temperature on the vein wall during endovasal laser treatment. At present study, a computer thermophysical model of the EVLT with TOTFC has been developed in the COMSOL Multiphysics 5.4 program (COMSOL Inc., Burlington, MA, USA). In the EVLT model, a laser radiation wavelength of 980 nm with an average laser power of 8–14 W to the traction speed of the optical fiber in range of 1–7 mm/s is applied. The dependence of the TOTFC temperature and the temperature on the vein wall has been numerically investigated. In accordance with Planck’s formula, the dependence of the spectral luminosity density of a blackbody simulating IR signal from TOTFC on its temperature has been determined. The spectral luminosity density in a wide range the wavelength of 0.4–20 μm, as well as in spectral ranges limited by the transmission of the quartz fiber and the sensitivity of Ge and PbS photodetectors was defined. The possibility of controlling the average power of the laser radiation depending on the magnitude of the change in the spectral luminosity density of TOTFC during EVLT is demonstrated. The results obtained can be useful in developing laser medical equipment and materials for use in vascular surgery at endovasal laser treatment.

Quantitative determination of cut efficiency during soft tissue surgery using diode lasers in the wavelength range between 400 and 1500 nm

Within the scope of this ex vivo study, the cut efficiency was investigated with eight diode laser wavelengths in the range from 400 to 1500 nm. Incisions on porcine gingiva samples were generated in CW-mode at a power range of 0.5–4 W using a bare fiber (∅ = 320 μm) in contact and non-contact mode at a cut speed of 2 mm/s. Cut depths, cut widths, and thermal damages were recorded based on histological sections and were evaluated via measurement masks. Moreover, with respect to the controllability of a therapeutic measure, an efficiency factor was defined. At powers above 2 W, for 445 nm, the maximum cut depth was 820 μm and 344 μm for 810 nm, respectively. At all wavelength and power ranges, the cut width averaged 125 μm. At minimum output power (0.5 W), the spatial expansion of the thermal damage in the tissue surface layer corresponds in the blue/green wavelength range from the very beginning of the laser impact to the fiber core diameter. It could be shown that increases in the diode laser power output do not correlate to the same extent with the incision depth nor with thermal damage to tissue.

Assessment of Effects of Laser Light Combining Three Wavelengths (450, 520 and 640 nm) on Temperature Increase and Depth of Tissue Lesions in an Ex Vivo Study

Background: Lasers are widely used in medicine in soft and hard tissue surgeries and biostimulation. Studies found in literature typically compare the effects of single-wavelength lasers on tissues or cell cultures. In our study, we used a diode laser capable of emitting three components of visible light (640 nm, red; 520 nm, green; 450 nm, blue) and combining them in a single beam. The aim of the study was to assess the effects of laser radiation in the visible spectrum on tissue in vitro, depending on the wavelength and pulse width. Methods: All irradiations were performed using the same output power (1.5 W). We used various duty cycles: 10, 50, 80 and 100% with 100 Hz frequency. Maximum superficial temperature, rate of temperature increase and lesion depth were investigated. Results: Maximum superficial temperature was observed for 450 + 520 nm irradiation (100% duty cycle). The highest rate of increase of temperature was noted for 450 + 520 nm (100% duty cycle). Maximum lesion depth was observed in case of three-wavelength irradiation (450 + 520 + 640 nm) for 100, 80 and 50% duty cycles. Conclusions: The synergistic effect of two-wavelength (450 + 520 nm) irradiation was observed in case of maximum temperature measurement. The deepest depth of lesion was noted after three-wavelength irradiation (450 + 520 + 640 nm).

Safety and Efficacy of 980nm Diode Laser for Brain Tumor Microsurgery-A Pioneer Case Series

BACKGROUND

Quality of life is essential for oncologic patients. Several tools are available to improve microsurgery and reduce morbidity. Diode laser is a precise and useful technology for microsurgery. The goal of this pioneer case series is to describe the oncologic use of the 980nm diode laser and the qualitative variables analyzed. Besides, review the current literature about lasers in neurosurgery.

METHODS

A longitudinal prospective study described patients with meningioma or glioma submitted to neurosurgical laser-assisted procedures. Also, we performed a review in medical databases using the terms "diode laser" and "neurosurgery."

RESULTS

No paper described the use of a diode laser in neurooncology. The 980nm diode laser was used in 15 patients. The device is thin, silent, and easy to handle. Excellent hemostasis was observed, especially in skull base meningiomas. Also, it was easy and fast to delimit tumor from normal brain tissue without damage to surrounding parenchyma. No postoperative complications occurred.

CONCLUSIONS

The diode laser is a useful tool for brain tumor surgery, particularly concerning hemostasis. Surgical site coagulation is effective without damage to adjacent structures, especially in gliomas near eloquent regions. We consider this technique a suitable adjuvant resource for brain tumor surgeries to provide an excellent hemostasis and help cut and vaporize a lesion.

A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO2, and Er:YAG)

Background: Gingival melanin hyperpigmentation is due to excessive deposition of melanin granules. The duration of pigmentation reappearance after treatment using different laser wavelengths remains controversial. Objective: The study aims to assess the longevity of gingival depigmentation (GD) and the consistency in esthetic results as three laser wavelengths (Er:YAG laser, CO₂ laser, and diode laser, 980 nm) were used in two different groups (smokers and nonsmokers). This is attained by comparing the periods of time in each group before pigmentation reappearance. Methods: Seventy-two subjects were divided into daily smokers (S) and nonsmokers. Subjects underwent a randomized GD with: Erbium laser (Er), CO₂ laser (CO₂), and Diode laser (Diode). The subjects were divided into six groups: S and nonsmokers were treated with three different wavelengths. Irradiation was performed until there was no visible pigmentation. For qualitative measurement, Hedin Melanin Index (HMI) was used, before treatment, after 2 weeks, and until 60 months. Pigmentation reappearance of degree 1 or above of the HMI was noted. Descriptive statistics were also calculated. Results: HMI showed a 0 in all groups after 14 days of treatment. The time before pigmentation rebound was: Diode > CO₂ > S-Diode > S-CO₂ > Er > S-Er. The first signs of relapse shown among all groups were seen in the group S-Er group. The longest time before rebound was observed with the Diode group for the nonsmoker. Conclusions: Diode laser provides the longest-term stability in treatment. Smoking negatively affects the longevity of GD. Er laser gives the shortest time before the reappearance of gingival pigmentation.

Temperature Depth Profiles Induced in Human Skin In Vivo Using Pulsed 975 nm Irradiation

BACKGROUND AND OBJECTIVES

The aim of this study was to determine the temperature depth profiles induced in human skin in vivo by using a pulsed 975 nm diode laser (with 5 ms pulse duration) and compare them with those induced by the more common 532 nm (KTP) and 1,064 nm (Nd:YAG) lasers. Quantitative assessment of the energy deposition characteristics in human skin at 975 nm should help design of safe and effective treatment protocols when using such lasers.

STUDY DESIGN/MATERIALS AND METHODS

Temperature depth profiles induced in the human skin by the three lasers were determined using pulsed photothermal radiometry (PPTR). This technique involves time-resolved measurement of mid-infrared emission from the irradiated test site and reconstruction of the laser-induced temperature profiles using an earlier developed optimization algorithm. Measurements were performed on volar sides of the forearms in seven volunteers with healthy skin. At irradiation spot diameters of 3-4 mm, the radiant exposures were 0.24, 0.36, and 5.7 J/cm² for the 975, 532, and 1,064 nm lasers, respectively.

RESULTS

Upon normalization to the same radiant exposure of 1 J/cm ² , the assessed maximum temperature rise in the epidermis averaged 0.8 °C for the 975 nm laser, 7.4 °C for the 532 nm, and 0.6 °C for the 1,064 nm laser. The characteristic subsurface depth to which 50% of the absorbed laser energy was deposited was on average 0.31 mm at 975 nm irradiation, and slightly deeper at 1,064 nm, and 0.15 mm at 532 nm. The experimentally obtained relations were reproduced in a dedicated numerical simulation.

CONCLUSIONS

The assessed energy deposition characteristics show that the pulsed 975 nm diode laser is very suitable for controlled heating of the upper dermis as required, for example, for nonablative skin rejuvenation. The risks of nonselective overheating of the epidermis and subcutis are significantly reduced in comparison with irradiation at 532 and 1,064 nm, respectively. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Effects of Different 980-nm Diode Laser Parameters in Hepatectomy

BACKGROUND AND OBJECTIVE

Despite the successful application of laser in animal experiments and clinics, the adjustment of laser parameters during surgery is still unclear. This study aimed to investigate the effect of different 980-nm diode laser parameters in hepatectomy. This could provide a clear protocol for using 980-nm diode laser in hepatectomy.

STUDY DESIGN/MATERIALS AND METHODS

In total, 48 Sprague-Dawley rats were used to explore the effects of different 980-nm diode laser parameters in hepatectomy, by setting different parameter combinations. The rats were randomly divided into eight groups, including the continuous wave group and quasi-continuous wave group. The effects were assessed in terms of liver resection speed, extent of intraoperative bleeding, and thermal damage.

RESULTS

In the quasi-continuous wave group, there was a significant difference in resection speed at the different laser parameters (P < 0.001); however, there was no significant difference in intraoperative bleeding and thermal damage. In the continuous wave group, there was a significant difference in resection speed, intraoperative bleeding, and thermal damage at different parameters.

CONCLUSION

The study showed that the average power determined hemostasis efficiency and thermal damage, and peak power determined the liver resection speed, whereas the pulse width and repetition frequency are not independent factors. When using 980-nm diode laser in hepatectomy, the average power should be decreased to prove hemostasis efficiency in delicate operations, and the peak power should be decreased to accelerate the procedure without worsening thermal damage. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.