Evaluations on laser ablation of ex vivo porcine stomach tissue for development of Ho:YAG-assisted endoscopic submucosal
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ORIGINAL ARTICLE
Evaluations on laser ablation of ex vivo porcine stomach tissue for development of Ho:YAG-assisted endoscopic submucosal dissection (ESD) Hanjae Pyo 1 & Hyeonsoo Kim 1 & Hyun Wook Kang 2 Received: 14 September 2020 / Accepted: 3 November 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Endoscopic submucosal dissection (ESD) is clinically used to remove early gastric cancer in stomach. The aim of the current study is to examine a therapeutic capacity of pulsed Ho:YAG laser for the development of laser-assisted ESD under various surgical parameters. Ex vivo porcine stomach tissue was ablated with 1-J Ho:YAG pulses at 10 Hz at different number of treatments (NT = 1, 2, and 3) and treatment speeds (TS = 0.5, 1, and 2 mm/s) without and with saline injection. Regardless of saline injection, straight tissue ablation showed that ablation depth increased with increasing NT and decreasing TS. At NT = 3 and TS = 0.5 mm/s, no saline injection yielded the maximum ablation depth (3.4 ± 0.3 mm), partially removing muscularis propria. However, saline injection confined the tissue ablation within a submucosal layer (2.1 ± 0.3 mm). Thermal injury was found to be 0.7~1.1 mm in the adjacent tissue with superficial carbonization. Circular tissue ablation (2 cm in diameter) at NT = 3 and TS = 0.5 mm/s presented that no saline injection yielded a reduction in the lesion area, whereas saline injection maintained the ablated lesion area. Histological analysis revealed that unlike no saline injection, saline injection ablated the entire mucosal layer without perforation in the muscular propria. The pulsed Ho:YAG laser can be a potential surgical tool for clinical ESD to incise a target lesion without adverse perforation. Further investigations will validate the efficacy and safety of the Ho:YAG laserassisted ESD in in vivo porcine stomach models for clinical translation. Keywords Ho:YAG laser . Laser ablation . Gastric cancer . Endoscopic submucosal dissection
Introduction Endoscopic submucosal dissection (ESD) is a stomachpreserving method to en bloc remove a gastric cancerous lesion from the human stomach. ESD is established with several steps: (1) injecting functional liquid into a submucosal layer to lift a mucosal layer from muscular propria, (2) cutting circumferential tissue of a lesion, and (3) dissecting the bottom of the lesion to detach the abnormal tissue out of the stomach [1–3]. Several studies have demonstrated the outstanding performance of ESD to treat early gastric cancer in terms of high resection rate and reduced recurrence [4, 5]. On the other * Hyun Wook Kang [email protected] 1
Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, South Korea
2
Department of Biomedical Engineering, Pukyong National University, Busan 48513, South Korea
hand, the potential risks of bleeding and perforation on the gastrointestinal tract still remain with possible complications caused by ESD [4, 6–8]. Furthermore, long operation time, difficulty of surger
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