In VivoCO2Laser Rat Urinary Bladder Welding with Silver Halide Fiberoptic Radiometric Temperature Control

Temperature controlled CO(2) laser welding of soft tissues: urinary bladder welding in different animal models (rats, rabbits, and cats)

BACKGROUND AND OBJECTIVE

Laser welding of tissues is a method of closure of surgical incisions that, in principle, may have advantages over conventional closure methods. It is a noncontact technique that introduces no foreign body, the closure is continuous and watertight, and the procedure is faster and requires less skill to master. However, in practice, there have been difficulties in obtaining strong and reliable welding. We assumed that the quality of the weld depends on the ability to monitor and control the surface temperature of the welded zone during the procedure. Our objective was to develop a "smart" fiberoptic laser system for controlled temperature welding.

STUDY DESIGN/MATERIALS AND METHODS

We have developed a welding system based on a CO(2) laser and on infrared transmitting AgClBr fibers. This fiberoptic system plays a double role: transmitting laser power for tissue heating and noncontact (radiometric) temperature monitoring and control. The "true" temperature of the heated tissue was determined by using an improved calibration method. We carried out long-studies of CO(2) laser welding of urinary bladders in various animal models. Cystotomies were performed on the animals, and complete closure of the bladder was obtained with a surface temperature of 55 +/- 5 degrees C at the welding site.

RESULTS

In early experiments on 31 rats, the success rate was 73%. In later experiments with 10 rabbits and 3 cats, there was an 80% and a 100% success rate, respectively.

CONCLUSION

The success rate in these preliminary experiments and the quality of the weld, as determined histologically, demonstrate that temperature controlled CO(2) laser welding can produce effective welding of tissues. The fiberoptic system can be adapted for endoscopic laser welding.

Controlled temperature photothermal tissue welding

Photothermal tissue welding has been investigated as an alternative surgical tool to improve bonding of a variety of severed tissues. Yet, after almost two decades of research, inconsistencies in interpretation of experimental reports and, consequently, mechanism of this photothermal process as well as control of dosimetry remain an enigma. Widespread clinical use may greatly depend on full automation of light dosimetry to perform durable and reproducible welds with minimal thermal damage to surrounding and/or underlying tissues. Recognizing photothermal damage as a rate process, radiometrically measured tissue surface temperature has been studied as an indirect marker of tissue status during laser irradiation. Dosimetry control systems and surgical devices were developed to perform controlled temperature tissue welding using surface temperature feedback from the site of laser impact. Nevertheless, end points that mark the completion of a durable and stable weld have not been precisely identified, and subsequently, not incorporated into dosimetry control algorithms. This manuscript reviews thermal dosimetry control systems of the 1990s in an attempt to systematically indicate the difficulties encountered so far and to elaborate on major issues for photothermal tissue welding to become a clinical reality in the new millennium. © 1999 Society of Photo-Optical Instrumentation Engineers.

Bladder welding in rats using controlled temperature CO2 laser system

PURPOSE

Laser tissue welding has potential advantages over conventional suture closure of surgical wounds. It is a noncontact technique that introduces no foreign body and limits the possibility of infections and complications. The closure could be immediately watertight and the procedure may be less traumatic, faster and easier. In spite of these positives laser welding has not yet been approved for wide use. The problem in the clinical implementation of this technique arises from the difficulty in defining the conditions under which a highly reliable weld is formed. We have assumed that the successful welding of tissues depends on the ability to monitor and control the surface temperature during the procedure, thereby avoiding underheating or overheating. The purpose of this work was to develop a laser system for reliable welding of urinary tract tissues under good temperature control.

MATERIALS AND METHODS

We have developed a "smart" laser system that is capable of a dual role: transmitting CO2 laser power for tissue heating, and noncontact (radiometric) temperature monitoring and control. Bladder opening (cystotomy) was performed in 38 rats. Thirty-three animals underwent laser welding. In 5 rats (control group) the bladder wound was closed with one layer of continuous 6-0 dexon sutures. Reliable welding was obtained when the surface temperature was kept at 71 + 5C. Quality of weld was controlled immediately after operation. The rats were sacrificed on days 2, 10 and 30 for histological study.

RESULTS

Bladder closure using the laser welding system was successful in 31/33 (94%) animals. Histological examination revealed an excellent welding and healing of the tissue.

CONCLUSIONS

Efficiency of laser welding of urinary bladder in rats was confirmed by high survival rate and quality of scar that was demonstrated by clinical and histological examinations. In the future, optimal laser welding conditions will be studied in larger animals, using CO2 lasers and other lasers, with deeper radiation penetration into tissues.