Experimental evaluation of a new system for laser tissue welding applied on damaged lungs

Diode-pumped neodymium:yttrium aluminum garnet laser effects on the visceral pleura in an ex vivo porcine lung model†

OBJECTIVES

Resection of tumour spread on a very thin visceral pleura might be challenging, and collateral damage to the lung parenchyma might occur. We aimed to develop an operative technique, which might facilitate the parenchyma-sparing destruction of the visceral pleura. This experimental work investigated the effects of a neodymium:yttrium aluminum garnet (Nd:YAG) laser on the visceral pleura in an ex vivo porcine lung model.

METHODS

We used a diode-pumped Nd:YAG laser (Limax® 120, KLS Martin, Tuttlingen, Germany) to investigate the effects on the visceral pleural in 20 porcine lungs. The laser was applied on a standardized length in 4 different settings: Group I (80 W, 6 s), Group II (80 W, 12 s), Group III (120 W, 6 s) and Group IV (120 W, 12 s). All specimens were analysed histologically.

RESULTS

The mean thickness of the visceral pleura was 81 ± 10 μm. Increasing power levels and longer application duration resulted in significantly enhanced laser destruction effects. The mean depths of the carbonization zone were 142 ± 42 µm, 378 ± 137 µm, 607 ± 155 µm and 1371 ± 271 μm for Groups I-IV, respectively (P < 0.001). The ratio of carbonization zone to pleural thickness was measured for each section (C/P ratio) to quantify the thermal effects. The corresponding C/P ratio for Groups I-IV were 1.72 ± 0.55, 4.98 ± 1.96, 7.11 ± 1.61 and 17.35 ± 4.35, respectively (P < 0.001).

CONCLUSIONS

Our study showed that increasing power levels and application duration of the laser lead to a significantly increased carbonization and destruction zones. Further in vivo human studies should evaluate the feasibility of laser application for a potential translational relevance for human use.

Principles and development of collagen-mediated tissue fusion induced by laser irradiation

The mechanism underlying tissue fusion mediated by laser irradiation remains unclear. We clarify the mechanisms underlying laser-mediated tissue fusion using a novel model. Microscopic examinations of morphological changes within the adventitia of a bovine carotid artery and a collagen sheet prepared from bovine dermis showed collagen fibril bundle loosening and collagen fibre swelling following heating at 46 °C. An incised bovine carotid artery covered with a collagen sheet to which pressure and laser heat of 40 °C–52 °C were applied created a structure that was pressure resistant to >300 mmHg. Microscopic analyses of the irradiation site showed collagen fibril interdigitation. Hence, low-temperature laser-mediated tissue fusion causes collagen fibril bundles to loosen and swell, and crimping causes the fibres to intertwine. As the temperature declines, the loosened and swollen fibrils and fibres tighten, and collagen fibre interdigitation is completed. This technology could be applied to fuse tissues during surgery.

Low-cost light-induced therapy to treat rickettsial infection

Antimicrobial photodynamic therapy uses a nontoxic photosensitizer with the assistance of harmless visible light to activate the photosensitizer. Consequently, the excited state of the photosensitizer interacts with molecular oxygen to produce reactive oxygen species, which have the antimicrobial effect. In this study, we evaluated the effect of photodynamic therapy on Vero cells infected with rickettsia using methylene blue as a photosensitizer along with red light. A significant reduction (by 96%) in the number of viable Rickettsia slovaca was determined by quantitative RT-PCR 48 h after the treatment with methylene blue followed by 30 min of red light excitation. A statistically significant reduction of R. slovaca was also recorded with pretreatment (by 99%). To the best of our knowledge, this result is the first one in the literature to confirm the effectiveness of photodynamic therapy for the elimination of R. slovaca and to suggest this technique as a good supportive treatment for rickettsial infections.