Bladder welding in rats using controlled temperature CO2 laser system

Esophageal Incisions Repair by CO2 Laser Soldering

PURPOSE: This study evaluated the feasibility of fiberoptic CO2 laser soldering for the repair of esophageal injuries under tight temperature feedback control in an animal model. Healing was compared to conventional suture closure.

MATERIALS AND METHODS: A CO2 soldering system equipped with infrared transmitting silver halide fibers was used. The soldered tissue temperature was monitored continuously, and laser power was adjusted to provide constant temperature. The procedure was done with 50% bovine serum albumin solder. Longitudinal incisions measuring 8 to 10 mm were made under general anesthesia in the cervical esophagus of 25 rats. Twenty rats (group I) underwent laser tissue bonding; 8 of which were tested in a preliminary study to determine optimal laser parameters. In the remaining 5 rats (group II, controls), closure was performed with 1 layer of 6/0 Vicryl sutures. The rats were sacrificed 2, 3, 4, and 6 weeks postoperatively, and the esophagus was examined histologically.

RESULTS: Optimal temperature was found to be 65 to 70° C and optimal exposure time, 150 to 200 seconds. Laser soldering was successful in 9 of the 12 rats (75%) treated under optimal settings; suturing was successful in 4 of the 5 control rats (80%). There were no significant differences between the groups in healing or complication rates.

CONCLUSIONS: These results indicate that the CO2 laser soldering technique is a valid option for the correction of esophageal tears or incisions in rats. The confirmation and extension of these findings in further studies with larger animals may ultimately lead to the routine in vivo use of temperature-controlled laser repair for the esophagus and other organs. This method lends itself to endoscopic bonding of tissues.

Corneal cut closure using temperature-controlled CO2 laser soldering system

We aimed to evaluate the effectiveness of temperature-controlled laser soldering for repair of large perforated corneas in a porcine model. Eight Yorkshire pigs aged 6 months underwent 6-mm-deep 180° crescent-shaped trephination of the central corneas. Right corneal injuries were repaired by placement of 47 % bovine albumin along the cut followed by CO2 laser soldering (power density 16 W/cm(2)) to a target temperature of 65(°). Left corneal injuries were repaired with 10/0 nylon sutures. The groups were compared for operative time, leakage, and histopathological findings. Mean tissue temperature was 63 ± 4 °C. Mean operative time was 31.57 ± 2.8 min in laser-soldered eyes and 41.38 ± 2.3 min in controls (p < 0.0001, unpaired Student's t test). Compared to controls, the soldered corneas had less neovascularization, complete re-epithelization, and mild stromal inflammation. There was no leakage in either group. Combined CO2 laser and radiometer is effective for the in vivo repair of corneal cuts. These results have important implications for modern corneal surgery. Further studies are needed in the clinical setting.

Wound healing in urology

Wound healing is a dynamic and complex phenomenon of replacing devitalized tissues in the body. Urethral healing takes place in four phases namely inflammation, proliferation, maturation and remodelling, similar to dermal healing. However, the duration of each phase of wound healing in urology is extended for a longer period when compared to that of dermatology. An ideal wound dressing material removes exudate, creates a moist environment, offers protection from foreign substances and promotes tissue regeneration. A single wound dressing material shall not be sufficient to treat all kinds of wounds as each wound is distinct. This review includes the recent attempts to explore the hidden potential of growth factors, stem cells, siRNA, miRNA and drugs for promoting wound healing in urology. The review also discusses the different technologies used in hospitals to treat wounds in urology, which make use of innovative biomaterials synthesised in regenerative medicines like hydrogels, hydrocolloids, foams, films etc., incorporated with growth factors, drug molecules or nanoparticles. These include surgical zippers, laser tissue welding, negative pressure wound therapy, and hyperbaric oxygen treatment.

Temperature-controlled laser-soldering system and its clinical application for bonding skin incisions

Laser tissue soldering is a method of repairing incisions. It involves the application of a biological solder to the approximated edges of the incision and heating it with a laser beam. A pilot clinical study was carried out on 10 patients who underwent laparoscopic cholecystectomy. Of the four abdominal incisions in each patient, two were sutured and two were laser soldered. Cicatrization, esthetical appearance, degree of pain, and pruritus in the incisions were examined on postoperative days 1, 7, and 30. The soldered wounds were watertight and healed well, with no discharge from these wounds or infection. The total closure time was equal in both methods, but the net soldering time was much shorter than suturing. There was no difference between the two types of wound closure with respect to the pain and pruritus on a follow-up of one month. Esthetically, the soldered incisions were estimated as good as the sutured ones. The present study confirmed that temperature-controlled laser soldering of human skin incisions is clinically feasible, and the results obtained were at least equivalent to those of standard suturing.

Therapeutic applications of lasers in urology: an update

There has been renewed interest in the use of lasers for minimally invasive treatment of urologic diseases in recent years. The introduction of more compact, higher power, less expensive and more user-friendly solid-state lasers, such as the holmium:yttrium-aluminum-garnet (YAG), frequency-doubled neodymium:YAG and diode lasers has made the technology more attractive for clinical use. The availability of small, flexible, biocompatible, inexpensive and disposable silica optical fiber delivery systems for use in flexible endoscopes has also promoted the development of new laser procedures. The holmium:YAG laser is currently the workhorse laser in urology since it can be used for multiple soft- and hard-tissue applications, including laser lithotripsy, benign prostate hyperplasia, bladder tumors and strictures. More recently, higher power potassium-titanyl-phosphate lasers have been introduced and show promise for the treatment of benign prostatic hyperplasia. On the horizon, newer and more effective photosensitizing drugs are being tested for potential use in photodynamic therapy of bladder and prostate cancer. Additionally, new experimental lasers such as the erbium:YAG, Thulium and Thulium fiber lasers, may provide more precise incision of soft tissues, more efficient laser lithotripsy and more rapid prostate ablation. This review provides an update on the most important new clinical and experimental therapeutic applications of lasers in urology over the past 5 years.

Temperature-controlled two-wavelength laser soldering of tissues

BACKGROUND AND OBJECTIVE

Laser tissue soldering is a method for bonding of incisions in tissues. A biological solder is spread over the cut, laser radiation heats the solder and the underlying cut edges and the incision is bonded. This method offers many advantages over conventional techniques (e.g., sutures). Past researches have shown that laser soldering, using a single laser, does not provide sufficient strength for bonding of cuts in thick (>1 mm) tissues. This study introduces a novel method for laser soldering of thick tissues, under temperature control, using two lasers, emitting two different wavelengths.

STUDY DESIGN/MATERIALS AND METHODS

An experimental system was built, using two lasers: (i) a CO(2) laser, whose radiation heated the upper surface of the tissue and (ii) a GaAs laser that heated an albumin layer under the tissue. An infrared fiber-optic radiometer monitored the temperature of the tissue. All three devices were connected to a computer that controlled the process. A computer simulation was written to optimize the system parameters. The system was tested on tissue phantoms, to validate the simulation and ensure that both the upper and lower sides of the cut were heated, and that the temperature could be controlled on both sides. The system was then used ex vivo to bond longitudinal cuts of lengths ∼12 mm in the esophagi of large farm pigs.

RESULTS

The theoretical simulations showed a good stabilization of the temperatures at the upper and lower tissue surfaces at the target values. Experiments on tissue phantom showed a good agreement with these simulations. Incisions in esophagi, removed from large farm pigs, were then successfully bonded. The mean burst pressure was ∼3.6 m of water.

CONCLUSIONS

This study demonstrated the capability of soldering cuts in thick tissues, paving the way for new types of surgical applications.

Novel laser tissue-soldering technique for dural reconstruction

OBJECT

The goal of this study was to use a modified version of the CO2 laser-soldering system to develop a simple and reliable technique for the repair of dural defects after excision of brain tumors.

METHODS

The authors used a CO2 fiber optic laser system that they had developed for heating, monitoring, and controlling tissue temperature in situ and in real time, thereby reducing damage to the brain parenchyma. They adapted the system for dural closure by using free fascial grafts in a porcine model. Measures for estimation of reconstruction quality included visual assessment under magnification and direct measurements of adhesive strength and cerebrospinal fluid leak (CSF) pressure. Reliable soldering was achieved in 54 of 57 experiments, providing a 95% success rate. The average peak adhesive strength was 82 +/- 3 mN/cm2. The measured leak pressure of the fascia-dura mater bond was 66 +/- 5 mm Hg. Conventional suturing performed using Prolene stitches resulted in immediate CSF leakage from areas between the stitches and from the area of the needle hole itself.

CONCLUSIONS

Fascia-dura mater soldering using the CO2 laser is feasible and may support CSF pressure up to six times higher than normal intracranial pressure. Findings of this study may provide a basis for the development of new tools for dural reconstruction.

Repair of pig dura in vivo using temperature controlled CO2 laser soldering

BACKGROUND AND OBJECTIVES

The purpose of this study was to demonstrate that laser soldering might be successfully used for closing holes or cuts in the dura layer, which encapsulates the brain.

STUDY DESIGN/MATERIALS AND METHODS

A temperature controlled fiberoptic CO(2) laser system and albumin solder were used for spot soldering of fascia patches to holes in the dura of farm pigs, in vitro and in vivo.

RESULTS

The mean burst pressure of the soldered patches in the in vitro experiments was 190 +/- 88 mm Hg-significantly higher than typical maximum CSF pressure of 15 mm Hg. In the in vivo experiments the pigs showed no postoperative complications. Histopathological studies exhibited an accepted level of inflammatory reaction and showed no thermal damage to the underlying brain tissue.

CONCLUSIONS

It has been clearly demonstrated that temperature controlled laser soldering is a very useful technique for the repair of the dura. It provides significant advantages over standard closure techniques: it is easy to apply, the bond is strong and watertight and the procedure is likely to be much faster than suturing. This research work will lead to clinical trials.

Temperature controlled burn generation system based on a CO2 laser and a silver halide fiber optic radiometer

BACKGROUND AND OBJECTIVES

Experimental animal study of burns is dependent on a reliable burn generation system. Most of the experimental systems used today are unable to produce precise partial thickness burns. This limits the ability to study minor changes associated with burn care. The aim of the study was to develop a method for generating burns with a fixed depth using a CO2 laser burn generation system.

MATERIALS AND METHODS

The burn generation system was composed of two components: a burn generation device and a temperature sensing and control system. These components were designed to operate together in order to keep a constant, predetermined skin surface temperature during prolonged burn generation. One hundred thirty-eight spot burns were generated on the back of five shaved 450 g male Wistar rats. The rat skin was exposed to a 70 degrees C for 5-60 seconds. The burned areas were excised and underwent evaluation by hematoxylin-eosin-stained slide microscopy.

RESULTS

A linear correlation was found between the duration of exposure and the average burn depth (r = 0.93). This correlation is represented by the equation: burn depth in millimeters = 0.012x (duration in seconds of skin exposure at 70 degrees C).

CONCLUSIONS

The fiber-optic-controlled laser burn generation system studied is a reliable tool for creating partial thickness as well as full thickness skin burns in rats.

Intraluminal albumin stent assisted laser welding for ureteral anastomosis

BACKGROUND AND OBJECTIVES

The success of laser tissue welding or soldering depends on optimal laser settings, solder material, and tissue type and geometry. To develop a practical laser welding technique for ureteral repair, an intraluminal albumin stent was designed to enhance the welding effects on ureteral end to end anastomosis.

STUDY DESIGN/MATERIALS AND METHODS

In vitro porcine ureters were anastomosed using an albumin stent alone, the albumin stent plus a solder, and the solder alone. All welding was performed with an 810-nm diode laser with either a continuous wave (1 W, CW) or two pulse modes (2 W, 3.3 Hz; 1 W, 5 Hz). Laser parameters, tensile strength (TS) and burst pressure (BP) of the ureteral anastomosis, and tissue thermal injury were measured.

RESULTS

In the 2-W pulse mode, BP in the albumin stent plus solder group (mean 185 mmHg) and the stent only group (mean 133 mmHg) were significantly higher than the solder only group (mean 77 mmHg, P < 0.05). Laser ureteral anastomosis with the stent plus solder group at 1-W CW and 2-W pulse laser modes yielded the highest TS (mean 97, 82 g) and BP (mean 183, 185 mmHg). Among the three modes, the 1 W pulse delivered the lowest energy and yielded the lowest TS and BP in ureteral anastomosis. There was no significant difference in the thermal damage to the tissue among the modes and groups.

CONCLUSIONS

Using the albumin stent increased the reliability of ureter end-to-end laser anastomosis. Further studies will be warranted in vivo and other tubular organs as well.

Soft tissue application of lasers

Despite increasing numbers of veterinarians incorporating lasers into their clinical practices, little information has been published about laser clinical applications in soft tissue surgery. This article reviews soft tissue interaction, describes laser equipment and accessories commonly marketed to veterinarians, and discusses clinical applications of the carbon dioxide laser in a systems-based approach. A table of recommended laser tips and settings based on the authors' experiences using a carbon dioxide laser (AccuVet Novapulse LX-20SP, Bothell, WA) is provided.

Laser soldering of rat skin, using fiberoptic temperature controlled system

BACKGROUND AND OBJECTIVE

Laser soldering of tissues is based on the application of a biological solder on the approximated edges of a cut. Our goal was to use laser soldering for sealing cuts in skin under temperature feedback control and compare the results with ones obtained using standard sutures.

STUDY DESIGN/MATERIALS AND METHODS

Albumin solder was applied onto the approximated edges of cuts created in rat skin. A fiberoptic system was used to deliver the radiation of a CO(2) laser, to heat a spot near the cut edges, and to control the temperature. Laser soldering was carried out, spot by spot, where the temperature at each spot was kept at 65-70 degrees C for 10 sec.

RESULTS

The tensile strength of laser-soldered cuts was measured after 3-28 days postoperatively and was found comparable to that of sutured cuts. Histopathological studies showed no thermal damage and less inflammatory reaction than that caused by standard sutures (P = 0.04).

CONCLUSIONS

Temperature controlled laser soldering of cuts in rat skin gave strong bonding. The cosmetic and histological results were very good, in comparison to those of standard sutures.