Schimberg AS, Klabbers TM, Wellenstein DJ, Heutink F, Honings J, van Engen-Van Grunsven I, Verdaasdonk RM, Takes RP, van den Broek GB. Optimizing Settings for Office-Based Endoscopic CO
2 Laser Surgery Using an Experimental Vocal Cord Model.
Laryngoscope 2020;
130:E680-E685. [PMID:
32022931 PMCID:
PMC7687150 DOI:
10.1002/lary.28518]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS
To provide insight in the thermal effects of individual laser settings in target tissues to optimize flexible endoscopic CO2 laser surgery treatment.
STUDY DESIGN
Experimental laboratory study.
METHODS
Thermal effects of the CO2 laser using a fiber delivery system were visualized using the color Schlieren technique in combination with a polyacrylamide gel tissue model. Variable settings were used for emission mode, power, laser fiber distance, and laser duration, which were evaluated in every possible combination. Collateral thermal expansion and incision depth were measured. To validate the model, the results were compared to histology after CO2 laser irradiation of ex vivo human vocal cords, and the intraclass correlation coefficient was calculated. Thermal damage and incision depth were measured by a blinded pathologist.
RESULTS
Of all parameters studied, duration of laser irradiation had the greatest effect on thermal expansion. Increased distance between laser tip and target tissue resulted in significantly reduced incision depth and increased thermal expansion. Pulsed emission modes led to increased incision depths. The intraclass correlation coefficient for consistency between the model setup and the ex vivo human vocal cords was classified as "fair."
CONCLUSIONS
By using high-intensity pulsed lasers at minimal distance to the target tissue, exposure times and subsequent damage to surrounding tissue can be reduced. If an evaporation technique is used, lower power in continuous wave at a larger distance to the target tissue will lead to superficial but broader thermal effects. The model setup used in this study is a valid model to investigate laser-induced thermal effects in vocal cord tissue.
LEVEL OF EVIDENCE
NA Laryngoscope, 130:E680-E685, 2020.
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