Ex vivo study of Ho:YAG and thulium fiber lasers for soft tissue surgery: which laser for which case?
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ORIGINAL ARTICLE
Ex vivo study of Ho:YAG and thulium fiber lasers for soft tissue surgery: which laser for which case? Mark Taratkin 1 & Anastasia Kovalenko 2 & Ekaterina Laukhtina 1 & Nina Paramonova 3 & Leonid Spivak 1 & Luca Johann Wachtendorf 4 & Semil Eminovic 4 & Andrew Sheya Afyouni 5 & Zhamshid Okhunov 5 & Marina Karagezyan 6 & Vasily Mikhailov 1 & Yuriy Strakhov 3 & Thomas RW Herrmann 7,8 & Dmitry Enikeev 1 Received: 12 May 2020 / Accepted: 4 November 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and Pav = 40 W or Pav = 70 W settings. The TFL was tested using E = 1.5 J and Pav = 30 W or Pav = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization. Keywords Ho:YAG laser . Thulium fiber laser . Laser-tissue interactions . Ex vivo
Introduction * Mark Taratkin [email protected] 1
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
2
NTO “IRE-Polus”, One Vvedenskogo Sq, Fryazino, Moscow Region, Russia 141120
3
Centralized Pathology Department, Sechenov University, Moscow, Russia
4
Faculty of Medicine, Philipps University Marburg, Marburg, Germany
5
Department of Urology, University of California, Irvine, CA, USA
6
Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
7
Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
8
Department of Urology, Hannover Medical School, Hannover, Germany
Fifty years passed since the introduction of lasers into urology [1]. Laser techniques stopped being just an interesting option for endourology and became its integral part. Currently, lasers are widely used in lithotripsy, benign prostatic hyperplasia (BPH) surgery, bladder cancer (BCa), and upper tract urinary carcinoma (UTUC) resection [2]. For the clinician, t
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