Laser cutting of bone tissue under bulk water with a pulsed ps-laser at 532 nm

Real-Time Monitoring of Thermal Phenomena during Femtosecond Ablation of Bone Tissue for Process Control

Femtosecond (fs) laser technology is currently being considered in innovative fields such as osteotomy and treatment of hard tissue thanks to the achievable high resolution and ability to prevent tissue damage. In a previous study, suitable process parameters were obtained to achieve competitive ablation rates on pork femur processing. Nevertheless, a better control of thermal accumulation in the tissue during laser ablation could further improve the postoperative regeneration of the treated bone compared with conventional procedures and push forward the exploitation of such technology. This study presents methods for real time analyses of bone tissue temperature and composition during fs laser ablation and highlights the importance of implementing an efficient cooling method of bone tissue in order to achieve optimized results. Results show that it is possible to achieve a larger process window for bone tissue ablation where bone tissue temperature remains within the protein denaturation temperature in water-based processing environment. This is a key outcome towards a clinical exploitation of the presented technology, where higher process throughputs are necessary. The effects of process parameters and environments on bone tissue were confirmed by LIBS technique, which proved to be an efficient method by which to record real-time variation of bone tissue composition during laser irradiation.

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.

Toward optoacoustic sciatic nerve detection using an all-fiber interferometric-based sensor for endoscopic smart laser surgery

Objectives

Laser surgery requires efficient tissue classification to reduce the probability of undesirable or unwanted tissue damage. This study aimed to investigate acoustic shock waves (ASWs) as a means of classifying sciatic nerve tissue.

Materials and Methods

In this study, we classified sciatic nerve tissue against other tissue types—hard bone, soft bone, fat, muscle, and skin extracted from two proximal and distal fresh porcine femurs—using the ASWs generated by a laser during ablation. A nanosecond frequency‐doubled Nd:YAG laser at 532 nm was used to create 10 craters on each tissue type's surface. We used a fiber‐coupled Fabry–Pérot sensor to measure the ASWs. The spectrum's amplitude from each ASW frequency band measured was used as input for principal component analysis (PCA). PCA was combined with an artificial neural network to classify the tissue types. A confusion matrix and receiver operating characteristic (ROC) analysis was used to calculate the accuracy of the testing‐data‐based scores from the sciatic nerve and the area under the ROC curve (AUC) with a 95% confidence‐level interval.

Results

Based on the confusion matrix and ROC analysis of the model's tissue classification results (leave‐one‐out cross‐validation), nerve tissue could be classified with an average accuracy rate and AUC result of 95.78  ± 1.3% and 99.58  ± 0.6%, respectively.

Conclusion

This study demonstrates the potential of using ASWs for remote classification of nerve and other tissue types. The technique can serve as the basis of a feedback control system to detect and preserve sciatic nerves in endoscopic laser surgery.

Ablation of Bone Tissue by Femtosecond Laser: A Path to High-Resolution Bone Surgery

Femtosecond lasers allow for high-precision, high-quality ablation of biological tissues thanks to their capability of minimizing the thermal loads into the irradiated material. Nevertheless, reported ablation rates remain still too limited to enable their exploitation on a clinical level. This study demonstrates the possibility to upscale the process of fs laser ablation of bone tissue by employing industrially available fs laser sources. A comprehensive parametric study is presented in order to optimize the bone tissue ablation rate while maintaining the tissue health by avoiding excessive thermal loads. Three different absorption regimes are investigated by employing fs laser sources at 1030 nm, 515 nm and 343 nm. The main differences in the three different wavelength regimes are discussed by comparing the evolution of the ablation rate and the calcination degree of the laser ablated tissue. The maximum of the ablation rate is obtained in the visible regime of absorption where a maximum value of 0.66 mm³/s is obtained on a non-calcined tissue for the lowest laser repetition rate and the lowest spatial overlap between successive laser pulses. In this regime, the hemoglobin present in the fresh bone tissue is the main chromophore involved in the absorption process. To the best of our knowledge, this is the highest ablation rate obtained on porcine femur upon fs laser ablation.

Sterile Tissue Ablation Using Laser Light—System Design, Experimental Validation, and Outlook on Clinical Applicability

Preparation of biological samples for further processing or analysis is generally performed manually by means of standard mechanical tools such as scalpels or biopsy punches. While this approach is uncomplicated and swift, it entails constraints such as low, operator-dependent cutting accuracy and reproducibility. Tissue segments surrounding the cut may further suffer mechanical and thermal damage due to shear forces and friction between tool and sample. These hindrances affect procedures both in the laboratory environment as well as within clinical settings. A system has been developed leveraging robotic positioning and laser light for precise, controlled, and contactless tissue ablation, and providing a concise and intuitive graphical user interface. Additionally, sterility of the process is demonstrated, a paramount element for clinical application. The proposed process does not require sterilization of the robotic components or the lasers, easing a prospective integration into existing workflows. In the context of this work, mainly cartilage repair surgery is targeted. The proposed system allows for highly accurate and reproducible shaping of the cartilage lesion area as well as its corresponding engineered cartilage graft, possibly leading to better and faster integration at the defect site. Promising results could be obtained in a first test series with human cartilage samples, validating the functionality of the preparation system and the feasibility of the sterility concept.

Evolution of surface morphology of Er:YAG laser-machined human bone

The extensive research on the laser machining of the bone has been, so far, restricted to drilling and cutting that is one- and two-dimensional machining, respectively. In addition, the surface morphology of the laser machined region has rarely been explored in detail. In view of this, the current work employed three-dimensional laser machining of human bone and reports the distinct surface morphology produced within a laser machined region of human bone. Three-dimensional laser machining was carried out using multiple partially overlapped pulses and laser tracks with a separation of 0.3 mm between the centers of consecutive laser tracks to remove a bulk volume of the bone. In this study, a diode-pumped pulse Er:YAG laser (λ = 2940 nm) was employed with continuously sprayed chilled water at the irradiation site. The resulting surface morphology evolved within the laser-machined region of the bone was evaluated using scanning electron microscopy, energy dispersive spectroscopy, and X-ray micro-computed tomography. The distinct surface morphology involved cellular/channeled scaffold structure characterized by interconnected pores surrounded by solid ridges, produced within a laser machined region of human structural bone. Underlying physical phenomena responsible for evolution of such morphology have been proposed and explained with the help of a thermokinetic model.

Thermal Effects in the Ablation of Bovine Cortical Bone with Pulsed Laser Sources

Lasers have advantages as bone surgical tools over mechanical methods, but two goals should be achieved to assure its use: Similar ablation rates to those obtained with mechanical tools (1 mm3/s at least) and to avoid thermal damage, a condition that can prevent proper bone healing. We present results of cow femoral bone with a 355 nm nanosecond (ns) and a 1064 nm picosecond (ps) pulsed laser sources that allow us to discuss the influence on the process of pulse duration and the selective ablation through high energy absorption (as bone highly absorbs 355 nm radiation). The treated samples were characterized by scanning electron microscopy (SEM) and Raman spectroscopy. The evaluation of the thermal effects produced in the samples shows clear differences between both laser sources: On one hand, the ns laser allows reaching high ablation rates (around 1 mm3/s); Raman spectra show no signal of bone carbonization, but unavoidable thermal effects in the form of melted and solidified material have been observed by electron microscopy in the samples treated with this laser. On the other hand, ablation without any sign of thermal effects is obtained using the ps laser, but with lower ablation rates, (around 0.15 mm3/s).