Devaux B C, Roux F X, Nataf F, Turak B, Cioloca C
Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France.
Surg Neurol. 1998 Jul;50(1):33-9; discussion 39-40. doi: 10.1016/s0090-3019(98)00042-1.
High-power semiconductor diode lasers were recently introduced and have been tested in ophthalmology and general surgery. These lasers are attractive from the practical and economical standpoint, and have enough power to perform most surgical procedures. They could replace other surgical lasers such as CO2, argon, 1.06 microm, and 1.32 microm Nd-YAG lasers for many applications in neurosurgery. We report our initial experience with the first available 0.805-microm surgical diode laser, the Diomed 25 (Diomed, Ltd, Cambridge, U.K.) in a series of 30 patients.
The diode laser was evaluated during surgical resection of various types of central nervous system tumors in 30 patients. It was used free-hand in 27 patients in contact and non-contact, continuous wave (cw) and pulsed modes, and during ventricular endoscopy in three patients. Average time of laser use during a procedure was 248 seconds. Output power ranged from 1 to 25 watts, with an average power per patient of 2.64 to 15.5 watts (mean, 8.78 watts). Total energy delivered ranged from 65 to 11,051 joules per patient.
Using 600- or 400-microm non-contact optic fiber, well pigmented tumor tissue hemostasis was obtained at cw 3 to 10 watts with a defocused beam, whereas vaporization required 10-25 cw or pulsed watts with a focused beam. Soft and tough tissue section could be obtained using a sculpted cone-shaped (600-300 microm tip) contact fiber at 7-10 cw watts after fiber tip charring. Because of the deeper penetration of 0.805-microm light in non-pigmented tissues, non-contact mode is not recommended for white matter or poorly vascularized tumors. The contact mode was not efficient on very soft tissues such as edematous brain parenchyma. The contact fibers proved to be very fragile because of heat generation.
The high power diode laser proved to be efficient for hemostasis, section and vaporization, using contact and non-contact modes, at different output powers. Economical and ergonomical advantages of this new generation of surgical lasers may cause them to replace other surgical lasers such as argon, CO2, and Nd-YAG lasers, mostly for tumor surgery.
高功率半导体二极管激光器最近被引入，并已在眼科和普通外科中进行了测试。从实际和经济的角度来看，这些激光器具有吸引力，并且有足够的功率来执行大多数外科手术。在神经外科的许多应用中，它们可以替代其他外科激光器，如二氧化碳、氩、1.06微米和1.32微米钕钇铝石榴石激光器。我们报告了我们在30例患者中使用第一台可用的0.805微米外科二极管激光器Diomed 25（Diomed有限公司，英国剑桥）的初步经验。
在30例患者的各种类型中枢神经系统肿瘤的手术切除过程中对二极管激光器进行了评估。在27例患者中，以接触和非接触、连续波（cw）和脉冲模式徒手使用该激光器，在3例患者的脑室内镜检查期间也使用了该激光器。手术过程中激光的平均使用时间为248秒。输出功率范围为1至25瓦，每位患者的平均功率为2.64至15.5瓦（平均8.78瓦）。每位患者传递的总能量范围为65至1,051焦耳。
使用600微米或400微米非接触光纤，在cw 3至10瓦时，通过散焦光束可实现色素沉着良好的肿瘤组织止血，而汽化则需要聚焦光束下10 - 25 cw或脉冲瓦。在光纤尖端炭化后，使用雕刻的锥形（600 - 300微米尖端）接触光纤在7 - 10 cw瓦时可获得软组织和坚韧组织的切片。由于0.805微米光在无色素组织中的穿透更深，因此不建议对白质或血管化不良的肿瘤使用非接触模式。接触模式对非常柔软的组织（如水肿的脑实质）效率不高。由于发热，接触光纤被证明非常脆弱。
高功率二极管激光器在不同输出功率下，通过接触和非接触模式，在止血、切片和汽化方面被证明是有效的。这种新一代外科激光器的经济和人体工程学优势可能使其取代其他外科激光器，如氩、二氧化碳和钕钇铝石榴石激光器，主要用于肿瘤手术。
