Prospect for feedback guided surgery with ultra-short pulsed laser light

Orthopedics-Related Applications of Ultrafast Laser and Its Recent Advances

The potential of ultrafast lasers (pico- to femtosecond) in orthopedics-related procedures has been studied extensively for clinical adoption. As compared to conventional laser systems with continuous wave or longer wave pulse, ultrafast lasers provide advantages such as higher precision and minimal collateral thermal damages. Translation to surgical applications in the clinic has been restrained by limitations of material removal rate and pulse average power, whereas the use in surface texturing of implants has become more refined to greatly improve bioactivation and osteointegration within bone matrices. With recent advances, we review the advantages and limitations of ultrafast lasers, specifically in orthopedic bone ablation as well as bone implant laser texturing, and consider the difficulties encountered within orthopedic surgical applications where ultrafast lasers could provide a benefit. We conclude by proposing our perspectives on applications where ultrafast lasers could be of advantage, specifically due to the non-thermal nature of ablation and control of cutting.

Heat impact during laser ablation extraction of mineralised tissue micropillars

The underlying constraint of ultrashort pulsed laser ablation in both the clinical and micromachining setting is the uncertainty regarding the impact on the composition of material surrounding the ablated region. A heat model representing the laser-tissue interaction was implemented into a finite element suite to assess the cumulative temperature response of bone during ultrashort pulsed laser ablation. As an example, we focus on the extraction of mineralised collagen fibre micropillars. Laser induced heating can cause denaturation of the collagen, resulting in ultrastructural loss which could affect mechanical testing results. Laser parameters were taken from a used micropillar extraction protocol. The laser scanning pattern consisted of 4085 pulses, with a final radial pass being 22 [Formula: see text] away from the micropillar. The micropillar temperature was elevated to 70.58 [Formula: see text], remaining 79.42 [Formula: see text] lower than that of which we interpret as an onset for denaturation. We verified the results by means of Raman microscopy and Energy Dispersive X-ray Microanalysis and found the laser-material interaction had no effect on the collagen molecules or mineral nanocrystals that constitute the micropillars. We, thus, show that ultrashort pulsed laser ablation is a safe and viable tool to fabricate bone specimens for mechanical testing at the micro- and nanoscale and we provide a computational model to efficiently assess this.

Osteoblast differentiation of bone marrow stromal cells by femtosecond laser bone ablation

This study examines the osteogenic effect of femtosecond laser bone ablation on bone mesenchymal stromal cells (BMSCs). Three-week old Sprague-Dawley (SD) rats were selected for experiments. Right tibias were ablated by a 10-W femtosecond laser (treated group), whereas left tibias were not subjected to laser ablation (control group). After ablation, BMSCs of both tibias were cultured and purified separately. Cell proliferation was then analyzed, as well as the expressions of RNA and several proteins (alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN)). The results suggest that femtosecond laser ablation promotes the differentiation of BMSCs and up-regulates the expression of ALP, RUNX2, and OCN, without affecting BMSC proliferation.

Can One Concurrently Record Electrical Spikes from Every Neuron in a Mammalian Brain?

The classic approach to measure the spiking response of neurons involves the use of metal electrodes to record extracellular potentials. Starting over 60 years ago with a single recording site, this technology now extends to ever larger numbers and densities of sites. We argue, based on the mechanical and electrical properties of existing materials, estimates of signal-to-noise ratios, assumptions regarding extracellular space in the brain, and estimates of heat generation by the electronic interface, that it should be possible to fabricate rigid electrodes to concurrently record from essentially every neuron in the cortical mantle. This will involve fabrication with existing yet nontraditional materials and procedures. We further emphasize the need to advance materials for improved flexible electrodes as an essential advance to record from neurons in brainstem and spinal cord in moving animals.

Modelling of the heat accumulation process during short and ultrashort pulsed laser irradiation of bone tissue

An analytical model is presented that qualitatively describes the cooling of a biological tissue after irradiation with short and ultrashort laser pulses. The assumption that the distribution of temperature at the initial moment of surface cooling repeats the distribution of the absorbed laser energy allowed us to use the thermal conductivity approximation in both cases. The experimental results of irradiation of dry bone with nanosecond and femtosecond laser pulses are compared with the calculated data. The necessity of taking into account the change in the optical parameters of hard tissue in the field of laser irradiation during its treatment by nanosecond and femtosecond laser pulses and the key role of residual heating in its carbonization around the exposure region is shown. The application of the model to a particular biological tissue can significantly simplify the search for optimal parameters of lasers for surgical procedures.

Investigation of random lasing as a feedback mechanism for tissue differentiation during laser surgery

Laser surgery provides clean, fast and accurate cutting of tissue. However, it is difficult to detect what kind of tissue is being cut. Therefore, a wrong cut may lead to iatrogenic damage of structures. A feedback system should automatically stop the cutting process when a nerve is reached or accidentally being cut to prevent its damage. This could increase the applicability and safety of using a laser scalpel in surgical procedures. In this study, random lasing (RL) is used to differentiate between skin, fat, muscle and nerve tissue. Among these tissue types, a special emphasis is made on the differentiation of nerve from the rest of the tissues, especially fat since nerve is covered by a fatty layer. The differentiation is done for ex-vivo tissues of a pig animal model. The results show that random lasing can be used to differentiate these tissue types also under room light conditions in open air.

Fs-laser ablation of teeth is temperature limited and provides information about the ablated components

The goal of this work is to investigate the thermal effects of femtosecond laser (fs-laser) ablation for the removal of carious dental tissue. Additional studies identify different tooth tissues through femtosecond laser induced breakdown spectroscopy (fsLIBS) for the development of a feedback loop that could be utilized during ablation in a clinical setting. Scanning Election Microscope (SEM) images reveal that minimal morphological damages are incurred at repetition rates below the carbonization threshold of each tooth tissue. Thermal studies measure the temperature distribution and temperature decay during laser ablation and after laser cessation, and demonstrate that repetition rates at or below 10kHz with a laser fluence of 40 J/cm² would inflict minimal thermal damage on the surrounding nerve tissues and provide acceptable clinical removal rates. Spectral analysis of the different tooth tissues is also conducted and differences between the visible wavelength fsLIBS spectra are evident, though more robust classification studies are needed for clinical translation. These results have initiated a set of precautionary recommendations that would enable the clinician to utilize femtosecond laser ablation for the removal of carious lesions while ensuring that the solidity and utility of the tooth remain intact.

The differentiation of oral soft- and hard tissues using laser induced breakdown spectroscopy - a prospect for tissue specific laser surgery

Compared to conventional techniques, Laser surgery procedures provide a number of advantages, but may be associated with an increased risk of iatrogenic damage to important anatomical structures. The type of tissue ablated in the focus spot is unknown. Laser-Induced Breakdown-Spectroscopy (LIBS) has the potential to gain information about the type of material that is being ablated by the laser beam. This may form the basis for tissue selective laser surgery. In the present study, 7 different porcine tissues (cortical and cancellous bone, nerve, mucosa, enamel, dentine and pulp) from 6 animals were analyzed for their qualitative and semiquantitative molecular composition using LIBS. The so gathered data was used to first differentiate between the soft- and hard-tissues using a Calcium-Carbon emission based classifier. The tissues were then further classified using emission-ratio based analysis, principal component analysis (PCA) and linear discriminant analysis (LDA). The relatively higher concentration of Calcium in the hard tissues allows for an accurate first differentiation of soft- and hard tissues (100% sensitivity and specificity). The ratio based statistical differentiation approach yields results in the range from 65% (enamel-dentine pair) to 100% (nerve-pulp, cancellous bone-dentine, cancellous bone-enamel pairs) sensitivity and specificity. Experimental LIBS measuring setup.

Characterization of wavefront errors in mouse cranial bone using second-harmonic generation

Optical aberrations significantly affect the resolution and signal-to-noise ratio of deep tissue microscopy. As multiphoton microscopy is applied deeper into tissue, the loss of resolution and signal due to propagation of light in a medium with heterogeneous refractive index becomes more serious. Efforts in imaging through the intact skull of mice cannot typically reach past the bone marrow ( ? 150 ?? ? m of depth) and have limited resolution and penetration depth. Mechanical bone thinning or optical ablation of bone enables deeper imaging, but these methods are highly invasive and may impact tissue biology. Adaptive optics is a promising noninvasive alternative for restoring optical resolution. We characterize the aberrations present in bone using second-harmonic generation imaging of collagen. We simulate light propagation through highly scattering bone and evaluate the effect of aberrations on the point spread function. We then calculate the wavefront and expand it in Zernike orthogonal polynomials to determine the strength of different optical aberrations. We further compare the corrected wavefront and the residual wavefront error, and suggest a correction element with high number of elements or multiconjugate wavefront correction for this highly scattering environment.

Noncontact monitoring of incision depth in laser surgery with air-coupled ultrasound transducers

Lack of haptic feedback during laser surgery makes it difficult to control the incision depth, leading to high risk of undesired tissue damage. Here, we present a new feedback sensing method that accomplishes noncontact real-time monitoring of laser ablation procedures by detecting shock waves emanating from the ablation spot with air-coupled transducers. Experiments in soft and hard tissue samples attained high reproducibility in real-time depth estimation of the laser-induced cuts. The advantages derived from the noncontact nature of the suggested monitoring approach are expected to advance the general applicability of laser-based surgeries.

Design and fabrication of a miniature objective consisting of high refractive index zinc sulfide lenses for laser surgery

A miniature laser ablation probe relying on an optical fiber to deliver light requires a high coupling efficiency objective with sufficient magnification in order to provide adequate power and field for surgery. A diffraction-limited optical design is presented that utilizes high refractive index zinc sulfide to meet specifications while reducing the miniature objective down to two lenses. The design has a hypercentric conjugate plane on the fiber side and is telecentric on the tissue end. Two versions of the objective were built on a diamond lathe-a traditional cylindrical design and a custom-tapered mount. Both received an antireflective coating. The objectives performed as designed in terms of observable resolution and field of view as measured by imaging a 1951 USAF resolution target. The slanted edge technique was used to find Strehl ratios of 0.75 and 0.78, respectively, indicating nearly diffraction-limited performance. Finally, preliminary ablation experiments indicated threshold fluence of gold film was comparable to similar reported probes.

Differentiation of cutaneous melanoma from surrounding skin using laser-induced breakdown spectroscopy

Laser-induced breakdown spectroscopy (LIBS) has the potential to be used as a surgical tool for simultaneous tissue ablation and elemental analysis of the ablated tissue. LIBS may be used to distinguish melanoma lesions from the surrounding dermis based on the quantitative difference of elements within melanoma lesions. Here, we measured the elements in homogenized pellets and real tissues from excised skin samples of melanoma-implanted mice. In addition, statistical analysis of LIBS spectra using principal component analysis and linear discriminant analysis was performed. Our results showed that this method had high detection sensitivity, highlighting the potential of this tool in clinical applications.

The effects of laser repetition rate on femtosecond laser ablation of dry bone: a thermal and LIBS study

The aim of this study is to understand the effect of varying laser repetition rate on thermal energy accumulation and dissipation as well as femtosecond Laser Induced Breakdown Spectroscopy (fsLIBS) signals, which may help create the framework for clinical translation of femtosecond lasers for surgical procedures. We study the effect of repetition rates on ablation widths, sample temperature, and LIBS signal of bone. SEM images were acquired to quantify the morphology of the ablated volume and fsLIBS was performed to characterize changes in signal intensity and background. We also report for the first time experimentally measured temperature distributions of bone irradiated with femtosecond lasers at repetition rates below and above carbonization conditions. While high repetition rates would allow for faster cutting, heat accumulation exceeds heat dissipation and results in carbonization of the sample. At repetition rates where carbonization occurs, the sample temperature increases to a level that is well above the threshold for irreversible cellular damage. These results highlight the importance of the need for careful selection of the repetition rate for a femtosecond laser surgery procedure to minimize the extent of thermal damage to surrounding tissues and prevent misclassification of tissue by fsLIBS analysis.

Preliminary fsLIBS study on bone tumors

The aim of this study is to evaluate the capability of femtosecond Laser Induced Breakdown Spectroscopy (fsLIBS) to discriminate between normal and cancerous bone, with implications to femtosecond laser surgery procedures. The main advantage of using femtosecond lasers for surgery is that the same laser that is being used to ablate can also be used for a feedback system to prevent ablation of certain tissues. For bone tumor removal, this technique has the potential to reduce the number of repeat surgeries that currently must be performed due to incomplete removal of the tumor mass. In this paper, we performed fsLIBS on primary bone tumor, secondary tumor in bone, and normal bone. These tissues were excised from consenting patients and processed through the UC Davis Cancer Center Biorepository. For comparison, each tumor sample had a matched normal bone sample. fsLIBS was performed to characterize the spectral signatures of each tissue type. A minimum of 20 spectra were acquired for each sample. We did not detect significant differences between the fsLIBS spectra of secondary bone tumors and their matched normal bone samples, likely due to the heterogeneous nature of secondary bone tumors, with normal and cancerous tissue intermingling. However, we did observe an increase in the fsLIBS magnesium peak intensity relative to the calcium peak intensity for the primary bone tumor samples compared to the normal bone samples. These results show the potential of using femtosecond lasers for both ablation and a real-time feedback control system for treatment of primary bone tumors.

Detection of plaque structure and composition using OCT combined with two-photon luminescence (TPL) imaging

BACKGROUND AND OBJECTIVES

Atherosclerosis and plaque rupture leads to myocardial infarction and stroke. A novel hybrid optical coherence tomography (OCT) and two-photon luminescence (TPL) fiber-based imaging system was developed to characterize tissue constituents in the context of plaque morphology.

STUDY DESIGN/MATERIALS AND METHODS

Ex vivo coronary arteries (34 regions of interest) from three human hearts with atherosclerotic plaques were examined by OCT-TPL imaging. Histological sections (4 μm in thickness) were stained with Oil Red O for lipid, Von Kossa for calcium, and Verhoeff-Masson Tri-Elastic for collagen/elastin fibers and compared with imaging results.

RESULTS

Biochemical components in plaques including lipid, oxidized-LDL, and calcium, as well as a non-tissue component (metal) are distinguished by multi-channel TPL images with statistical significance (P < 0.001). TPL imaging provides complementary optical contrast to OCT (two-photon absorption/emission vs scattering). Merged OCT-TPL images demonstrate the distribution of lipid deposits in registration with detailed plaque surface profile.

CONCLUSIONS

Results suggest that multi-channel TPL imaging can effectively identify lipid sub-types and different plaque components. Furthermore, fiber-based hybrid OCT-TPL imaging simultaneously detects plaque structure and composition, improving the efficacy of vulnerable plaque detection and characterization.

Smart surgical tool

A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

Real-time monitoring of incision profile during laser surgery using shock wave detection

Lack of sensory feedback during laser surgery prevents surgeons from discerning the exact location of the incision, which increases duration and complexity of the treatment. In this study we demonstrate a new method for monitoring of laser ablation procedures. Real-time tracking of the exact three dimensional (3D) lesion profile is accomplished by detection of shock waves emanating from the ablation spot and subsequent reconstruction of the incision location using time-of-flight data obtained from multiple acoustic detectors. Here, incisions of up to 9 mm in depth, created by pulsed laser ablation of fresh bovine tissue samples, were successfully monitored in real time. It was further observed that, by utilizing as little as 12 detection elements, the incision profile can be characterized with accuracy below 0.5 mm in all three dimensions and in good agreement with histological examinations. The proposed method holds therefore promise for delivering high precision real-time feedback during laser surgeries.

Characterization of multiphoton microscopy in the bone marrow following intravital laser osteotomy

The bone marrow is an important site where all blood cells are formed from hematopoietic stem cells and where hematologic malignancies such as leukemia emerge. It is also a frequent site for metastasis of solid tumors such as breast cancer and prostate cancer. Intravital microscopy is a powerful tool for studying the bone marrow with single cell and sub-cellular resolution. To improve optical access to this rich biological environment, plasma-mediated laser ablation with sub-microjoule femtosecond pulses was used to thin cortical bone. By locally removing a superficial layer of bone (local laser osteotomy), significant improvements in multiphoton imaging were observed in individual bone marrow compartments in vivo. This work demonstrates the utility of scanning laser ablation of hard tissue with sub-microjoule pulses as a preparatory step to imaging.

Characterization of femtosecond laser-induced breakdown spectroscopy (fsLIBS) and applications for biological samples

We characterize the femtosecond laser-induced breakdown spectroscopy (fsLIBS) signal for biological tissues as a function of different excitation parameters with femtosecond laser systems. These parameters include laser energy, depth of focus, and number of pulses per focal volume. We used femtosecond laser pulses of 800 nm and energy between 25 and 123 μJ to generate LIBS signals in biological tissues. As expected, we observed a linear increase in the fsLIBS intensity as a function of the laser energy. In addition, we show that moving the beam out of focus and the presence of overlapping pulses on the same focal area leads to a decrease in fsLIBS intensity due to changes in focal spot size. We also demonstrate that fsLIBS can distinguish between different biological tissue samples.

Engineering approaches to illuminating brain structure and dynamics

Historical milestones in neuroscience have come in diverse forms, ranging from the resolution of specific biological mysteries via creative experimentation to broad technological advances allowing neuroscientists to ask new kinds of questions. The continuous development of tools is driven with a special necessity by the complexity, fragility, and inaccessibility of intact nervous systems, such that inventive technique development and application drawing upon engineering and the applied sciences has long been essential to neuroscience. Here we highlight recent technological directions in neuroscience spurred by progress in optical, electrical, mechanical, chemical, and biological engineering. These research areas are poised for rapid growth and will likely be central to the practice of neuroscience well into the future.

All-optical osteotomy to create windows for transcranial imaging in mice

Surgical procedures as a prelude to optical imaging are a rate-limiting step in experimental neuroscience. Towards automation of these procedures, we describe the use of nonlinear optical techniques to create a thinned skull window for transcranial imaging. Metrology by second harmonic generation was used to map the surfaces of the skull and define a cutting path. Plasma-mediated laser ablation was utilized to cut bone. Mice prepared with these techniques were used to image subsurface cortical vasculature and blood flow. The viability of the brain tissue was confirmed via histological analysis and supports the utility of solely optical techniques for osteotomy and potentially other surgical procedures.