NTO IRE Polus, One Vvedenskogo Sq, Fryazino, 141190, Russian Federation.
Research Institute for Urology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya St., 2, Building 1, Moscow, 119435, Russian Federation.
Lasers Surg Med. 2020 Jun;52(5):437-448. doi: 10.1002/lsm.23158. Epub 2019 Sep 13.
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 CO . 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.
Ex vivo data show that laser-induced ablation and coagulation processes do not differ substantially between CO 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.
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. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
评估新型蓝激光二极管（蓝激光）、铥光纤激光（Tm 激光）及其组合作为腹腔镜肾部分切除术（LPN）中一种定向能量手术工具的可行性。
研究设计/材料与方法：测试了发射波长为 442nm 的蓝激光、发射波长为 1940nm 的 Tm 激光，以及它们的组合。首先，在空气中和 CO2 环境下对猪肾进行离体实验，评估激光的切割和凝固能力。通过组织学染色评估消融和凝固效率。然后，在零缺血的猪模型上进行实验性 LPN。切除双侧肾脏的上、下段。测量总手术时间和切除时间；评估出血和碳化情况。
离体数据表明，激光诱导的消融和凝固过程在 CO2 和空气环境中没有显著差异。离体切口的组织学分析表明，蓝激光产生了深的消融，具有相对较窄的凝固区，而 Tm 激光在消融方面效率较低，但具有良好的凝固特性。实验性 LPN 显示，蓝激光提供快速切割，碳化最小，而 Tm 激光切割缓慢，碳化严重。蓝激光和 Tm 激光的组合提供了最有希望的结果，显示出最高的切除率，几乎无碳化的切除表面和临床可接受的止血效果，使 LPN 无需血管夹闭。
蓝激光可有效地用于 LPN。此外，将蓝激光和 Tm 激光组合成单一模式可能有利于成功的激光辅助 LPN 的进一步发展。激光外科医学。© 2019 年 Wiley 期刊出版公司
