Bölükbas Servet, Greve Thorsten, Biancosino Christian, Eberlein Michael, Schumacher Sarah, Gödde Daniel, Störkel Stephan, Redwan Bassam
Department of Thoracic Surgery, Kliniken Essen-Mitte Evang. Huyssens-Stiftung/Knappschafts-Krankenhaus, Essen, Germany.
Department of Thoracic Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany.
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):339-343. doi: 10.1093/icvts/ivy254.
Resection of tumour spread on a very thin visceral pleura might be challenging, and collateral damage to the lung parenchyma might occur. We aimed to develop an operative technique, which might facilitate the parenchyma-sparing destruction of the visceral pleura. This experimental work investigated the effects of a neodymium:yttrium aluminum garnet (Nd:YAG) laser on the visceral pleura in an ex vivo porcine lung model.
We used a diode-pumped Nd:YAG laser (Limax® 120, KLS Martin, Tuttlingen, Germany) to investigate the effects on the visceral pleural in 20 porcine lungs. The laser was applied on a standardized length in 4 different settings: Group I (80 W, 6 s), Group II (80 W, 12 s), Group III (120 W, 6 s) and Group IV (120 W, 12 s). All specimens were analysed histologically.
The mean thickness of the visceral pleura was 81 ± 10 μm. Increasing power levels and longer application duration resulted in significantly enhanced laser destruction effects. The mean depths of the carbonization zone were 142 ± 42 µm, 378 ± 137 µm, 607 ± 155 µm and 1371 ± 271 μm for Groups I-IV, respectively (P < 0.001). The ratio of carbonization zone to pleural thickness was measured for each section (C/P ratio) to quantify the thermal effects. The corresponding C/P ratio for Groups I-IV were 1.72 ± 0.55, 4.98 ± 1.96, 7.11 ± 1.61 and 17.35 ± 4.35, respectively (P < 0.001).
Our study showed that increasing power levels and application duration of the laser lead to a significantly increased carbonization and destruction zones. Further in vivo human studies should evaluate the feasibility of laser application for a potential translational relevance for human use.
切除在非常薄的脏层胸膜上扩散的肿瘤可能具有挑战性，并且可能会对肺实质造成附带损伤。我们旨在开发一种手术技术，该技术可能有助于在保留实质的情况下破坏脏层胸膜。这项实验工作在离体猪肺模型中研究了钕钇铝石榴石（Nd:YAG）激光对脏层胸膜的影响。
我们使用二极管泵浦的Nd:YAG激光（Limax® 120，KLS Martin，德国图特林根）研究其对20个猪肺脏层胸膜的影响。激光以4种不同设置施加在标准化长度上：第一组（80瓦，6秒），第二组（80瓦，12秒），第三组（120瓦，6秒）和第四组（120瓦，12秒）。所有标本均进行组织学分析。
脏层胸膜的平均厚度为81±10微米。功率水平的增加和照射时间的延长导致激光破坏效果显著增强。第一至四组碳化区的平均深度分别为142±42微米、378±137微米、607±155微米和1371±271微米（P<0.001）。测量每个切片的碳化区与胸膜厚度之比（C/P比）以量化热效应。第一至四组相应的C/P比分别为1.72±0.55、4.98±1.96、7.11±1.61和17.35±4.35（P<0.001）。
我们的研究表明，激光功率水平和照射时间的增加会导致碳化和破坏区显著增加。进一步的人体体内研究应评估激光应用对于人类潜在转化相关性的可行性。
