Robot-assisted laser tissue soldering system

An Augmented Reality Visor for Intraoperative Visualization, Guidance, and Temperature Monitoring Using Fluorescence

Fluorescence-guided surgeries, including tumor resection and tissue soldering, are advancing the frontiers of surgical precision by offering enhanced control that minimizes tissue damage, improving recovery and outcomes. However, integrating fluorescence visualization with real-time temperature monitoring remains a challenge, limiting broader clinical use. We address this issue with an augmented reality (AR) visor that combines nanomaterial excitation, fluorescence detection, and temperature monitoring. Using advanced fluorescent nanoparticles like indocyanine green-doped particles and carbon nanotubes, the visor provides a comprehensive view of both the surgical field and sub-surface conditions invisible to the naked eye. This integration improves the safety and efficacy of fluorescence-guided surgeries, including laser tissue soldering, by ensuring optimal temperatures and laser guidance in real time. The presented technology enhances existing surgical techniques and supports the development of new strategies and sensing technologies in areas where traditional methods fall short, marking significant progress in precision surgery and potentially improving patient care.

Thulium doped all-fiber laser based on a double-cladding Bragg grating via femtosecond laser plane-by-plane writing technology

The fiber Bragg grating (FBG) is fabricated by the femtosecond laser writing technique with a plane-by-plane (Pl-by-Pl) method in the double-cladding fiber (DCF). The refractive index modified (RIM) region formed by this method is 12 μm × 8 μm in size. Due to the Pl-by-Pl method, high-order Bragg resonances with reflectance greater than 99% can be achieved. The fabricated high-quality FBG features a narrow full width at 3 dB bandwidth of approximately 0.45 nm, a high reflectivity above 99%, and almost no side-mode peaks. To investigate the application of fabricated FBGs, we have built a thulium-doped all-fiber oscillator with purely forward-pumped structures. A thulium-doped fiber laser (TDFL) at a central wavelength of 1953.79 nm was constructed by using the prepared fiber grating. The signal-to-noise ratio (SNR) is above 56 dB. When the pump power is 19 W, the total output power of the continuous wave is 4 W, and the output efficiency is 25.6%. In addition, the numerical calculation has been carried out to further optimize the output power. This work provides a possible approach for designing and implementing a continuous Tm-doped fiber laser with enhanced output efficiency.

Robotic Laser Tissue Soldering for Atraumatic Soft Tissue Fusion Guided by Fluorescent Nanothermometry

Minimally invasive surgical techniques, including endoscopic and robotic procedures, continue to revolutionize patient care, for their ability to minimize surgical trauma, thus promoting faster recovery and reduced hospital stays. Yet, the suturing of soft tissues ensuring damage-free tissue bonding during these procedures remains challenging due to missing haptics and the fulcrum effect. Laser tissue soldering has potential in overcoming these issues, offering atraumatic seamless tissue fusion. To ensure the precision and safety of laser tissue soldering, the study introduces feedback-controlled fluorescent nanothermometry-guided laser tissue soldering using nanoparticle-protein solders within endoscopic and robotic contexts. Temperature-sensitive fluorescent nanoparticles embedded in the solder provide surgeons with immediate feedback on tissue temperatures during laser application, all while within the confines of minimally invasive (robotic) surgical setups. By integrating fluorescent nanothermometry-guided laser tissue surgery into endoscopic and robotic surgery, the study paves the way for a new approach for safe and atraumatic soft tissue joining, especially in regions where traditional suturing is unfeasible.

Bubble dynamics and speed of jets for needle-free injections produced by thermocavitation

Significance

The number of injections administered has increased dramatically worldwide due to vaccination campaigns following the COVID-19 pandemic, creating a problem of disposing of syringes and needles. Accidental needle sticks occur among medical and cleaning staff, exposing them to highly contagious diseases, such as hepatitis and human immunodeficiency virus. In addition, needle phobia may prevent adequate treatment. To overcome these problems, we propose a needle-free injector based on thermocavitation.

Aim

Experimentally study the dynamics of vapor bubbles produced by thermocavitation inside a fully buried 3D fused silica chamber and the resulting high-speed jets emerging through a small nozzle made at the top of it. The injected volume can range from ∼ 0.1 to 2    μ L per shot. We also demonstrate that these jets have the ability to penetrate agar skin phantoms and ex-vivo porcine skin.

Approach

Through the use of a high-speed camera, the dynamics of liquid jets ejected from a microfluidic device were studied. Thermocavitation bubbles are generated by a continuous wave laser (1064 nm). The 3D chamber was fabricated by ultra-short pulse laser-assisted chemical etching. Penetration tests are conducted using agar gels (1%, 1.25%, 1.5%, 1.75%, and 2% concentrations) and porcine tissue as a model for human skin.

Result

High-speed camera video analysis showed that the average maximum bubble wall speed is about 10 to 25 m/s for almost any combination of pump laser parameters; however, a clever design of the chamber and nozzle enables one to obtain jets with an average speed of ∼ 70    m / s . The expelled volume per shot (0.1 to 2    μ l ) can be controlled by the pump laser intensity. Our injector can deliver up to 20 shots before chamber refill. Penetration of jets into agar of different concentrations and ex-vivo porcine skin is demonstrated.

Conclusions

The needle-free injectors based on thermocavitation may hold promise for commercial development, due to their cost and compactness.

Laser tissue soldering of the gastrointestinal tract: A systematic review LTS of the gastrointestinal tract

Background

Laser Tissue Soldering (LTS) is a promising tissue bonding technique in which a solder is applied between the tissues and then irradiated by laser, causing it to solidify and form links with the tissue.

Methods

A comprehensive systematic review summarizing the state of research of LTS in the gastrointestinal tract.

Results

Most studies were conducted on large animal tissues, using liquid proteinaceous solder, and irradiated by a continuous wave laser at 808 nm. LTS can provide better sealing and burst pressure than conventional methods. The application of LTS on top of or in addition to sutures showed an impressive increase in burst pressures. LTS may decrease the inflammatory and foreign body reaction caused by sutures.

Conclusions

LTS has strong potential to be applied in a clinical setting in leak prevention and in closure of gastrointestinal structures as an adjunct or additional anastomotic technology, decreasing leak rates, morbidity, and mortality.

Cyanine-Doped Nanofiber Mats for Laser Tissue Bonding

In spite of an extensive body of academic initiatives and innovative products, the toolkit of wound dressing has always revolved around a few common concepts such as adhesive patches and stitches and their variants. Our work aims at an alternative solution for an immediate restitutio ad integrum of the mechanical functionality in cutaneous repairs. We describe the fabrication and the application of electrospun mats of bioactive nanofibers all made of biocompatible components such as a natural polysaccharide and a cyanine dye for use as laser-activatable plasters, resembling the ultrastructure of human dermis. In particular, we investigate their morphological features and mechanical moduli under conditions of physiological relevance, and we test their use to bind a frequent benchmark of connective tissue as rabbit tendon and a significant case of clinical relevance as human dermis. Altogether, our results point to the feasibility of a new material for wound dressing combining translational potential, strength close to human dermis, extensibility exceeding 15% and state-of-art adhesive properties.

Quantitative investigation of laser ablation based on real-time temperature variations and OCT images for laser treatment applications

BACKGROUND AND OBJECTIVE

Lasers are widely employed in clinical applications. In vivo monitoring of real-time information about different-wavelength laser surgeries would provide important surgical feedback for surgeons or clinical therapy instruments. However, the quantitative effect of laser ablation or vaporization still needs to be further explored and investigated. Here, we investigate and quantitatively evaluate the ablation variations and morphological changes of two laser ablation models: point- and sweeping-based models.

METHODS

An infrared thermal imager was used to monitor the temperature variations, and curve fitting was used to build the relationship between the laser radiation duration/sweeping speed and quantitative parameters of the ablated areas. Optical coherence tomography (OCT) images were used to visualize the inner structure and evaluate the depth of the ablated craters. Optical attenuation coefficients (OACs) were computed to characterize the normal and ablated tissues.

RESULTS

The results demonstrated that there was a good linear relationship between radiation duration and temperature variation. Similarly, a linear relationship was observed between the sweeping speed and quantitative parameters of craters or scratches (width and depth). The mean OAC of normal tissues was significantly distinguished from the mean OACs of the ablated craters or scratches.

CONCLUSION

Laser ablation was investigated based on a quantitative parameter analysis, thermal detection, and OCT imaging, and the results successfully demonstrated that there is a linear relationship between the laser parameters and quantitative parameters of the ablated tissues under the current settings. Such technology could be used to provide quantitative solutions for exploring the laser-tissue biological effect and improve the performance of medical image-guided laser ablation in the future.

Robotic-arm-assisted flexible large field-of-view optical coherence tomography

Optical coherence tomography (OCT) is a three-dimensional non-invasive high-resolution imaging modality that has been widely used for applications ranging from medical diagnosis to industrial inspection. Common OCT systems are equipped with limited field-of-view (FOV) in both the axial depth direction (a few millimeters) and lateral direction (a few centimeters), prohibiting their applications for samples with large and irregular surface profiles. Image stitching techniques exist but are often limited to at most 3 degrees-of-freedom (DOF) scanning. In this work, we propose a robotic-arm-assisted OCT system with 7 DOF for flexible large FOV 3D imaging. The system consists of a depth camera, a robotic arm and a miniature OCT probe with an integrated RGB camera. The depth camera is used to get the spatial information of targeted sample at large scale while the RGB camera is used to obtain the exact position of target to align the image probe. Eventually, the real-time 3D OCT imaging is used to resolve the relative pose of the probe to the sample and as a feedback for imaging pose optimization when necessary. Flexible probe pose manipulation is enabled by the 7 DOF robotic arm. We demonstrate a prototype system and present experimental results with flexible tens of times enlarged FOV for plastic tube, phantom human finger, and letter stamps. It is expected that robotic-arm-assisted flexible large FOV OCT imaging will benefit a wide range of biomedical, industrial and other scientific applications.

Femtosecond Laser Plane-by-Plane Inscribed Cavity Mirrors for Monolithic Fiber Lasers in Thulium-Doped Fiber

A monolithic fiber laser operating in the short wavelength infrared that is suitable for CO2 gas sensing applications is proposed and presented. The current study reports a laser design based on the direct inscription of a monolithic Fabry-Perot (FP) cavity in a thulium-doped optical fiber using the femtosecond laser (FsL) plane-by-plane inscription method to produce the cavity mirrors. The FP cavity was inscribed directly into the active fiber using two wavelength-identical fiber Bragg gratings (FBGs), one with high and one with low reflectivity. Initially the effective length of the fiber was defined using a single high reflectivity FBG and subsequently a very weak FBG was inscribed at the other end of the fiber in order to demonstrate a fully monolithic fiber laser. All fiber lasers were designed for continuous wave operation at 1950 nm and characterized with respect to the power output, slope efficiency, stability, and effective resonator length. The performance of the presented monolithic laser cavities was evaluated using the same active fiber as a reference fiber spliced to FBGs inscribed in passive fiber; an improvement exceeding 12% slope efficiency is reported for the presented monolithic laser.

Optically activated and interrogated plasmonic hydrogels for applications in wound healing

We disclose the use of hybrid materials featuring Au/Ag core/shell nanorods in porous chitosan/polyvinyl alcohol scaffolds for applications in tissue engineering and wound healing. The combination of Au and Ag in a single construct provides synergistic opportunities for optical activation of functions as near infrared laser tissue bonding, and remote interrogation to return parameters of prognostic relevance in wound healing monitoring. In particular, the bimetallic component ensures optical tunability, enhanced shelf life and photothermal stability, serves as a reservoir of germicidal silver cations, and changes in near-infrared and visible color according to the environmental level of oxidative stress. At the same time, the polymeric blend is ideal to bind connective tissue upon photothermal activation, and to support fabrication processes that provide high porosity, such as electrospinning, thus putting all the premises for cellular repopulation and antimicrobial protection.

Strong bonding of corneal incisions using a noncontact fiber-optic laser soldering method

Suturing of corneal incisions requires significant skill. We demonstrate a noncontact method that will simplify the bonding process. 5-mm-long penetrating vertical and slanted incisions were made in corneas of eyes, extracted from dead piglets. A fiber-optic laser system was used for laser soldering of the incisions, under close temperature control, using albumin solder. The burst-pressure PB immediately after the soldering was found to be PB  ≈  92 and 875 mmHg, for vertical and slanted incisions, respectively. PB  =  875  mmHg is an exceptionally high figure, ≈10 times the clinically acceptable value for sutured incisions. Laser soldering was then performed on penetrating incisions made in the corneas of live healthy piglets, of weight ≈10  Kg. After a healing period, the eyes were extracted, and the corneas were examined by histopathology and by optical coherence tomography. Our method immediately generated watertight and strong bonding without noticeable corneal shape distortion. These results would be beneficial for cataract surgery and for corneal transplantations. The fiber-optic system makes it much easier to bond corneal incisions. In the future, laser soldering could be automated and efficiently used by less experienced surgeons, thereby reducing the workload on the experienced ones.

Mid-infrared Lasers for Medical Applications: introduction to the feature issue

This feature issue contains a series of papers that report the most recent advances in the field of mid-infrared light sources used for medical applications, including tissue imaging, reconstruction, excision, and ablation. Many biomolecular compounds have strong resonances in the mid-infrared region and medicine is ideally suited to exploit this. The precision, sterility, and versatility of light in mid-infrared is opening more opportunities and this feature issue captures some of the most exciting.