Explosive onset of continuous wave laser tissue ablation.

The phenomena at the onset of and during tissue ablation using continuous wave lasers were studied. Aortic and myocardial bovine tissues were exposed in air and in water to Nd-YAG (10 to 60 W) and argon (3.5 W) laser light. The transmitted light was measured, the surface of the tissue was filmed and the tissue was processed for histology. Three distinct phases were observed. Phase A was tissue denaturation. Phase B started with explosive vaporisation ('popcorn') in conjunction with a drop of about 50% in light transmission due to enhanced reflection and scattering. The 'popcorn' is possibly associated with a layered structure of the tissue. Phase C started with carbonisation of the tissue beginning in the centre and expanding in a cyclic fashion while the tissue was vaporised leaving a crater. Forward light transmission did not decrease. Thin layers of carbon (20 microns) and vacuoles (30 microns) suggested a large temperature gradient along the tissue ablation front. The ablation velocity was constant (r greater than 0.92) and tissue dependent. Reported models on laser tissue ablation need to be extended to include explosive vaporisation ('popcorn') at the onset and cyclic carbonisation during steady-state crater formation.