Reduction of thermocoagulative injury via use of a picosecond infrared laser (PIRL) in laryngeal tissues

TY - JOUR

T1 - Reduction of thermocoagulative injury via use of a picosecond infrared laser (PIRL) in laryngeal tissues

AU - Böttcher, Arne

AU - Kucher, Stanislav

AU - Knecht, Rainald

AU - Jowett, Nathan

AU - Krötz, Peter

AU - Reimer, Rudolph

AU - Schumacher, Udo

AU - Anders, Sven

AU - Münscher, Adrian

AU - Dalchow, Carsten V

AU - Miller, R J Dwayne

PY - 2015/4/1

Y1 - 2015/4/1

N2 - The carbon dioxide (CO2) laser is routinely used in glottic microsurgery for the treatment of benign and malignant disease, despite significant collateral thermal damage secondary to photothermal vaporization without thermal confinement. Subsequent tissue response to thermal injury involves excess collagen deposition resulting in scarring and functional impairment. To minimize collateral thermal injury, short-pulse laser systems such as the microsecond pulsed erbium:yttrium-aluminium-garnet (Er:YAG) laser and picosecond infrared laser (PIRL) have been developed. This study compares incisions made in ex vivo human laryngeal tissues by CO2 and Er:YAG lasers versus PIRL using light microscopy, environmental scanning electron microscopy (ESEM), and infrared thermography (IRT). In comparison to the CO2 and Er:YAG lasers, PIRL incisions showed significantly decreased mean epithelial (59.70 µm) and subepithelial (22.15 µm) damage zones (p < 0.05). Cutting gaps were significantly narrower for PIRL (133.70 µm) compared to Er:YAG and CO2 lasers (p < 0.05), which were more than 5 times larger. ESEM revealed intact collagen fibers along PIRL cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 and Er:YAG laser incisions. IRT demonstrated median temperature rise of 4.1 K in PIRL vocal fold incisions, significantly less than for Er:YAG laser cuts (171.85 K; p < 0.001). This study has shown increased cutting precision and reduced lateral thermal damage zones for PIRL ablation in comparison to conventional CO2 and Er:YAG lasers in human glottis and supraglottic tissues.

AB - The carbon dioxide (CO2) laser is routinely used in glottic microsurgery for the treatment of benign and malignant disease, despite significant collateral thermal damage secondary to photothermal vaporization without thermal confinement. Subsequent tissue response to thermal injury involves excess collagen deposition resulting in scarring and functional impairment. To minimize collateral thermal injury, short-pulse laser systems such as the microsecond pulsed erbium:yttrium-aluminium-garnet (Er:YAG) laser and picosecond infrared laser (PIRL) have been developed. This study compares incisions made in ex vivo human laryngeal tissues by CO2 and Er:YAG lasers versus PIRL using light microscopy, environmental scanning electron microscopy (ESEM), and infrared thermography (IRT). In comparison to the CO2 and Er:YAG lasers, PIRL incisions showed significantly decreased mean epithelial (59.70 µm) and subepithelial (22.15 µm) damage zones (p < 0.05). Cutting gaps were significantly narrower for PIRL (133.70 µm) compared to Er:YAG and CO2 lasers (p < 0.05), which were more than 5 times larger. ESEM revealed intact collagen fibers along PIRL cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 and Er:YAG laser incisions. IRT demonstrated median temperature rise of 4.1 K in PIRL vocal fold incisions, significantly less than for Er:YAG laser cuts (171.85 K; p < 0.001). This study has shown increased cutting precision and reduced lateral thermal damage zones for PIRL ablation in comparison to conventional CO2 and Er:YAG lasers in human glottis and supraglottic tissues.

U2 - 10.1007/s00405-015-3501-4

DO - 10.1007/s00405-015-3501-4

M3 - SCORING: Journal article

C2 - 25575843

VL - 272

SP - 941

EP - 948

JO - EUR ARCH OTO-RHINO-L

JF - EUR ARCH OTO-RHINO-L

SN - 0937-4477

IS - 4

ER -