Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, 48513, South Korea.
Department of Biomedical Engineering, Pukyong National University, Busan, 48513, South Korea.
Lasers Med Sci. 2021 Sep;36(7):1437-1444. doi: 10.1007/s10103-020-03182-0. Epub 2020 Nov 6.
Endoscopic submucosal dissection (ESD) is clinically used to remove early gastric cancer in stomach. The aim of the current study is to examine a therapeutic capacity of pulsed Ho:YAG laser for the development of laser-assisted ESD under various surgical parameters. Ex vivo porcine stomach tissue was ablated with 1-J Ho:YAG pulses at 10 Hz at different number of treatments (NT = 1, 2, and 3) and treatment speeds (TS = 0.5, 1, and 2 mm/s) without and with saline injection. Regardless of saline injection, straight tissue ablation showed that ablation depth increased with increasing NT and decreasing TS. At NT = 3 and TS = 0.5 mm/s, no saline injection yielded the maximum ablation depth (3.4 ± 0.3 mm), partially removing muscularis propria. However, saline injection confined the tissue ablation within a submucosal layer (2.1 ± 0.3 mm). Thermal injury was found to be 0.7~1.1 mm in the adjacent tissue with superficial carbonization. Circular tissue ablation (2 cm in diameter) at NT = 3 and TS = 0.5 mm/s presented that no saline injection yielded a reduction in the lesion area, whereas saline injection maintained the ablated lesion area. Histological analysis revealed that unlike no saline injection, saline injection ablated the entire mucosal layer without perforation in the muscular propria. The pulsed Ho:YAG laser can be a potential surgical tool for clinical ESD to incise a target lesion without adverse perforation. Further investigations will validate the efficacy and safety of the Ho:YAG laser-assisted ESD in in vivo porcine stomach models for clinical translation.
内镜黏膜下剥离术（ESD）临床上用于切除胃内早期胃癌。本研究旨在研究脉冲 Ho:YAG 激光在各种手术参数下用于激光辅助 ESD 的治疗能力。使用 1-J Ho:YAG 脉冲以 10 Hz 的频率在不同的治疗次数（NT = 1、2 和 3）和治疗速度（TS = 0.5、1 和 2 mm/s）下对离体猪胃组织进行消融，不进行和进行盐水注射。无论是否进行盐水注射，直线组织消融均表明消融深度随 NT 的增加和 TS 的降低而增加。在 NT = 3 和 TS = 0.5 mm/s 时，不进行盐水注射可获得最大的消融深度（3.4 ± 0.3 mm），部分切除固有肌层。然而，盐水注射将组织消融局限于黏膜下层（2.1 ± 0.3 mm）。在相邻组织中发现热损伤为 0.7~1.1 mm，伴有浅表碳化。在 NT = 3 和 TS = 0.5 mm/s 时进行的圆形组织消融（直径 2 cm）表明，不进行盐水注射会减少病变面积，而盐水注射则维持消融病变面积。组织学分析显示，与不进行盐水注射不同，盐水注射可在不穿孔固有肌层的情况下消融整个黏膜层。脉冲 Ho:YAG 激光可能成为临床 ESD 的潜在手术工具，可在不发生不良穿孔的情况下切割目标病变。进一步的研究将验证 Ho:YAG 激光辅助 ESD 在体内猪胃模型中的疗效和安全性，以进行临床转化。
