Comparison of A 1940 nm Thulium-Doped Fiber Laser and A 1470 nm Diode Laser for Cutting Efficacy and Hemostasis in A Pig Model of Spleen Surgery

Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review

Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the "see and treat" approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through "see and treat" hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.

Dumbbell-Shaped Ho-Doped Fiber Laser Mode-Locked by Polymer-Free Single-Walled Carbon Nanotubes Saturable Absorber

We propose a simple dumbbell-shaped scheme of a Holmium-doped fiber laser incorporating a minimum number of optical elements. Mode-locking regimes were realized with the help of polymer-free single-walled carbon nanotubes (SWCNTs) synthesized using an aerosol (floating catalyst) CVD method. We show that such a laser scheme is structurally simple and more efficient than a conventional one using a ring cavity and a similar set of optical elements. In addition, we investigated the effect of SWCNT film transmittance, defined by the number of 40 nm SWCNT layers on the laser's performance: operating regimes, stability, and self-starting. We found that three SWCNT layers with an initial transmittance of about 40% allow stable self-starting soliton mode-locking at a wavelength of 2076 nm with a single pulse energy of 0.6 nJ and a signal-to-noise ratio of more than 60 dB to be achieved.

Local Effects of a 1940 nm Thulium-Doped Fiber Laser and a 1470 nm Diode Laser on the Pulmonary Parenchyma: An Experimental Study in a Pig Model

The lungs are a common site of metastases from malignant tumors. Their removal with a minimal but safe tissue margin is essential for the long-term survival of patients. The aim of this study was to evaluate the usefulness of a 1940 nm thulium-doped fiber laser (TDFL) and a 1470 nm diode laser (DL) in a pig model of lung surgery that involved the incision and excision of lung tissue. Histopathological analysis was performed on days 0 and 7 after surgery. Neither TDFL nor DL caused significant perioperative or postoperative bleeding. Histological analysis revealed the presence of carbonized necrotic tissue, mixed fibrin-cellular exudate in the superficial zone of thermal damage and bands of deeper thermal changes. The mean total width of thermal damage on day 0 was 499.46 ± 61.44 and 937.39 ± 109.65 µm for TDFL and DL, respectively. On day 7, cell activation and repair processes were visible. The total width of thermal damage was 2615.74 ± 487.17 µm for TDFL vs. 6500.34 ±1118.02 µm for DL. The superficial zone of thermal damage was narrower for TDFL on both days 0 and 7. The results confirm the effectiveness of both types of laser in cutting and providing hemostasis in the lungs. TDFL caused less thermal damage to the lung parenchyma than DL.

Diode Laser Hysteroscopic Metroplasty for Dysmorphic Uterus: a Pilot Study

This paper aims to study the efficacy and safety of diode laser hysteroscopic metroplasty for dysmorphic uterus and the impact on reproductive outcomes. This is a retrospective, single-center pilot study with prospective follow-up. The study was performed at a university-affiliated, tertiary hospital. From February 2018 to February 2020, all nulliparous women with a 3D ultrasound diagnosis of T-shaped or Y-shaped dysmorphic uterus and diagnosis of infertility, recurrent implantation failure, or recurrent pregnancy losses were referred for hysteroscopic metroplasty. Diode laser hysteroscopic metroplasty was performed under general anesthesia in an ambulatory setting. Main outcome measures included operative time, complications, hysteroscopic appearance of the cavity in a follow-up hysteroscopy, and reproductive outcomes in terms of pregnancy and live birth. A total of 25 infertile women with mean duration of infertility of 56.6 ± 36.1 months underwent hysteroscopic metroplasty. No complications were reported, and subsequent 3D ultrasound and follow-up hysteroscopic appearance were satisfactory in all cases. Maximum follow-up was 32 months (mean ± standard deviation 11.5 ± 9.2 months). Fifteen nulliparous women returned for fertility treatments in our institute, among whom nine conceived (60% pregnancy rate). The rate of deliveries and ongoing pregnancies (pregnancies beyond 24 weeks of gestation) was 78% (7/9), with six successful liveborn deliveries at 36-38 weeks and one ongoing pregnancy. One had spontaneous abortion at week 19 and one had a spontaneous abortion at week 7. Hysteroscopic metroplasty in an ambulatory setting, using diode laser, is a safe and effective procedure, improving reproductive outcomes in cases of T-shaped or Y-shaped uterus.

Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery-Comparative Study in Pig Model

Background: The aim of this study was to evaluate the usefulness of a thulium-doped fiber laser and a diode laser in zero ischemia kidney surgery, by carrying out a comparative study in a pig model. Material and methods: Research was carried out on 12 pigs weighing 30 kg each. A thulium-doped fiber laser (TDFL) and a diode laser (DL) operating at wavelengths of 1940 and 1470 nm, respectively, were used. The cut sites were assessed both macroscopically and microscopically. The zone of thermal damage visible in the histopathological preparations was divided into superficial and total areas. Results: During partial nephrectomy, moderate to minimal bleeding was observed, which did not require additional hemostatic measures. All animals survived the procedure. On day 0, the total thermal damage depth was 837.8 µm for the TDFL and 1175.0 µm for the DL. On day 7, the depths were 1556.2 and 2301.7 µm, respectively. On day 14, the overall thermal damage depth for the DL was the greatest (6800 µm). The width of the superficial zone was significantly reduced on days 7 and 14 after TDFL application. Conclusion: Both lasers are suitable for partial wedge nephrectomy without ischemia in pigs. The TDFL produced similar or better hemostasis than the DL, with a smaller zone of thermal damage and, therefore, seems more suitable for application in human medicine.

The use of Thulium-Doped Fiber Laser (TDFL) 1940 nm as an energy device in liver parenchyma resection, a-pilot-study in Indonesia

Introduction

Several modalities are used to improve the outcome of liver resection surgery. Laser-based surgery may become promising option; therefore we aim to report our experience regarding the efficacy and safety of Thulium-Doped Fiber Laser (TDFL) 1940 nm in liver parenchyma resection.

Methods

A cross sectional study in which patients with pre-existing liver pathology during July 2019 and July 2020 were randomly assigned to receive liver resection using TDFL integrated with raman laser emitting at 1940 nm and 1470 nm wavelength. Data on estimated blood loss during liver transection, liver transection speed, morbidity rate, and postoperative variables including complications, length of hospital stay (days), and mortality were analyzed.

Results

A total of 17 consecutive liver resections were performed, among them are 7 major and 11 minor hepatectomies. The Multipulse TM+1470 were used on 8 procedures consisted of 1 major and 7 minor hepatectomies, the mean amount of blood loss during operation and liver transection was 628.13 ± 141.31 mL and 294.63 ± 94.81 ml, respectively. The mean liver transection speed was 1.52 ± 0.27 cm²/min. No biliary leak, post-hepatectomy-liver failure, and mortality were reported.

Conclusion

TDFL provided by Multipulse TM+1470 is an effective and safe tool for liver surgery, providing good hemostasis and allowing for safe and effective exposure of vascular. Further study with larger samples might be needed proved the efficacy and safety of TDFL in liver surgery.

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Despite promising laser device features, the usage in liver surgery is still rare.

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TDFL provides precision transection and good hemostasis.

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Low intraoperative blood loss is observed in TDFL liver surgery.

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No bile leak and post hepatectomy liver failure was observed after TDFL surgery.