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1.
Twenty-eight partial nephrectomies were performed on nine pigs with a simultaneous, coaxial CO2-Nd:YAG laser at power settings of 20 W and 40 W, or with a steel scalpel. A vascular pedicle clamp was used without renal cooling. The time for hemostasis was 4.5 ± 3.2 min (mean ± SD) with the laser and 6.4 ± 2.5 min with the steel scalpel (P = 0.064). There was no difference in the total operation time (10.4 ± 3.5 min with the laser vs. 11.0 ± 3.2 min with the steel scalpel, P = 0.470). The mean blood loss with the laser was 17.5 ± 6.7 g and 22.1 ± 15.2 g with the steel scalpel (P = 0.299). The number of ligatures needed for complete hemostasis was 2.9 ± 2.1 with the laser and 5.0 ± 2.3 with the steel scalpel (P = 0.011). The average thermal damage was 0.23 ± 0.10 mm. It is concluded that the simultaneous CO2-Nd:YAG laser method can be used in partial nephrectomy and it offers better hemostasis than the conventional technique. Further studies with different power levels are needed. © 1994 Wiley-Liss, Inc.  相似文献   

2.
Twenty-four partial nephrectomies were performed in 18 piglets using either the combination Nd:YAG laser technique (contact and noncontact) or a steel scalpel. Additional haemostasis was attempted with ligatures. Blood loss, operation time, and number of ligatures were compared in the two treatment groups. Twelve piglets had a two-week follow-up. The mean blood loss with the laser was 72 +/- 10 g and 83 +/- 13 g with the steel scalpel (no significant difference). The resection time until complete haemostasis was 9.8 +/- 0.9 min with the laser and 14.3 +/- 1.3 min with the steel scalpel (p = 0.0076). The number of ligatures needed for complete haemostasis was 2.8 +/- 0.4 with the laser and 7.5 +/- 1.0 with the steel scalpel (p = 0.0051). Three piglets in the steel scalpel group developed urinomas. There were two perirenal abscesses, one in each group. In the steel scalpel group there was one intussusception. In conclusion, it seems that the combination Nd:YAG laser method offers no definitive advantage over the standard technique for partial nephrectomies in the pig.  相似文献   

3.
Twelve partial nephrectomies were performed in 12 piglets using either the combination (contact and non-contact) Nd:YAG laser technique or a steel scalpel. Additional haemostasis was attempted with ligatures. The renal artery was not clamped and renal cooling was not attempted. Total nephrectomy was performed on the contralateral side. Serum creatinine and urea levels were measured, and 99mTc-DTPA renography was performed pre-operatively and 1 and 2 weeks post-operatively. One week post-operatively the mean serum creatinine level was 35% higher than the pre-operative level in the laser group and 30% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 34 and 24%. The mean urea level 1 week after operation was 50% higher than the pre-operative level in the laser group and 17% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 38% in the laser group and 20% in the steel scalpel group. The mean DTPA disappearance rate was 34% lower 1 week after operation in the laser group and 23% lower in the steel scalpel group when compared with the preoperative state. Two weeks post-operatively the respective changes were 48 and 25%. These data indicate that there is no significant difference in renal function when the Nd: YAG combination laser technique is used in partial nephrectomy as compared with the steel scapel.  相似文献   

4.
Z D Wu 《中华外科杂志》1991,29(6):384-6, 398
We conducted an experimental and clinical study of hepatectomy with Nd:YAG laser. The results showed that cutting effect artificial sapphire contact Nd:YAG laser scalpel was better than that of quartz fiber contact and noncontact Nd:YAG laser. The tissue damage was minimal in the former group whereas, the blood loss was similar in both groups. Seven patients were operated on, with quartz fiber and 12 with artificial sapphire laser scalpel. No complications were related to the use of laser. We consider that partial liver resection can be performed effectively with artificial sapphire contact Nd:YAG laser scalpel because of its better cutting, coagulation effects, and less tissue damage.  相似文献   

5.
The Nd: YAG contact laser technique with 12 W power output was used in partial nephrectomies in six piglets. Blood loss, total time and number of ligatures needed for haemostasis were compared in six partial nephrectomies performed with a steel scalpel. Mean blood loss was 53 g with the laser and 108 g with the steel scalpel (p less than 0.04). The mean time needed for haemostasis were 9.5 and 16.2 min respectively (p = 0.2) and the average number of ligatures required 1.5 and 8.8, respectively. The mean temperature rise at 5, 10 and 20 mm distance from the resection line was 5.3, 1.2 and 0.3 degrees C, respectively. The use of laser reduced blood loss and shortened the operation time. Further studies are needed concerning renal function after kidney surgery with a laser.  相似文献   

6.
Steel scalpel, electrocautery, CO2 laser used in a continuous wave mode (CW) and rapid superpulse mode (RSP), and contact Nd: YAG laser were tested on pig skin incisions. Speed of incision and histological changes near the wounds were examined. Light microscopical observations were made on postoperative day 0 using standard Van Gieson stain. Width of the scar on postoperative day 14 was also measured. Steel scalpel produced the least pathological changes in the skin, followed by RSP. Electrocautery did not differ significantly from the CO2 lasers in this respect on postoperative day 0. The damage was larger after contact Nd:YAG laser. The situation was essentially similar on postoperative day 14. The width of the scar was narrowest after steel scalpel and widest after contact Nd:YAG laser (p less than 0.01; Nd:YAG vs. other methods). Electrocautery and the two CO2 lasers produced equal scarring. However, electrocautery was significantly faster than any of the lasers (p less than 0.001).  相似文献   

7.
Many theoretical advantages over conventional surgical techniques have been attributed to the Nd: YAG contact laser. Clinically significant differences in perioperative results between the Nd: YAG contact laser and standard surgery, however, are not well defined. The present study was undertaken to evaluate the Nd: YAG contact laser compared with standard scalpel and/or electrocautery in curative operations for head and neck cancer. Clinical records of 36 patients undergoing head and neck cancer surgery were reviewed retrospectively. Patients were studied in three groups: 9 previously irradiated patients operated upon using the Nd: YAG laser (Nd:YAG); 9 previously irradiated patients operated upon using conventional techniques (conventional/RT); 18 nonirradiated patients operated upon using conventional techniques (conventional/no RT). These groups underwent 14,14, and 25 procedures, respectively. Differences between the Nd: YAG, conventional/RT, and conventional/no RT groups regarding cancer staging, age, procedures performed, operative time, intraoperative blood loss, and hospital and ICU stay were not statistically significant. Preoperative radiotherapy dosages in the Nd: YAG and conventional/RT groups were similar (5,127 ± 842 vs. 604 ± 2,373 cGy). Postoperative morbidity in Nd: YAG patients (11%) was similar to that of the conventional/no RT group (17%) and was significantly reduced compared to conventional/RT (11% vs. 56%, P < 0.05). Clinical outcome, including operative time, blood loss, and hospital and ICU stay using the Nd: YAG contact laser in curative operations on previously irradiated patients with head and neck cancer, is equal to that of conventional surgical techniques, with or without preoperative radiotherapy. Among patients operated upon after receiving radiation therapy for head and neck cancer, the Nd: YAG contact laser significantly reduces postoperative morbidity. The data indicate that the Nd: YAG contact laser is an effective surgical technique in head and neck oncology. © 1994 Wiley-Liss, inc.  相似文献   

8.
The aim of this study was to evaluate and compare the healing process after surgical treatment of chemically induced lesions in the lateral edge of tongue of hamsters performed with scalpel, electrocautery, carbon dioxide (CO2) laser radiation or neodymium:yttrium–aluminum–garnet (Nd:YAG) laser radiation. Eighty hamsters of both sexes were used and examined at postoperative days 7, 14, 21 and 28 by histological and histomorphometric analysis of the skeletal muscle fibers. In the histological analysis it was observed that the dynamics of the healing process was faster in the group treated by scalpel than in the other groups. The histomorphometric observation of the skeletal muscle fibers was submitted to one-way analysis of variance (ANOVA) and Tukey’s multiple comparison test, with a level of significance set at P?<?0.05, which showed that the amount of skeletal muscle fiber formed had significantly increased in the group treated by scalpel in comparison with that in the groups treated by electrocautery (P?<?0.01), CO2 laser irradiation (P?<?0.001) and Nd:YAG laser irradiation (P?<?0.01) on the 14th postoperative day. A gradual increase in skeletal muscle fibers formed during the healing process was observed in all groups. When the laser irradiated groups were compared, it was possible to conclude that tissue organization and vascularization were faster and more intense in the Nd:YAG laser irradiated group than in the CO2 laser irradiated group.  相似文献   

9.
The tissue effects of the steel scalpel, electrocautery, CO2 laser and contact Nd-YAG laser were studied on rat tongue. The tip of the tongue (3 mm) was cut off and fixed for histology. The rats (6-10/method/age group) were kept alive for 2, 7 and 14 days, when the remaining tongue was resected. In each postoperative age group the effects to the epithelium and muscular layer were determined separately. Peroperative bleeding was measured and attention was paid to wound contraction and inflammatory cell infiltration.Postoperative bleeding occurred with the steel scalpel and electrocautery, but not with the lasers. A significant delay in early re-epithelialization was observed after the use of all thermal knives. Resection with steel scalpel was found to result in the smallest damage to the tissues on day 0 (P< 0.01), whereas on day 7 no significant differences were observed between scalpel, electrocautery and CO2 laser. On the other hand there was a significant difference between scalpel and contact Nd-YAG laser (P< 0.05). On day 14 these differences were no longer significant.Wound contraction on days 7 and 14 was evident after scalpel incision and slight after thermal knives.The steel scalpel causes less tissue damage than the thermal knives, whereas the advantages of a bloodless operation can be achieved with both lasers used in this study.  相似文献   

10.
Hyperplastic fibro-epithelial lesions are the most common tumor-like swellings in the mouth. The neodymium yttrium aluminium garnet (Nd:YAG) laser appears to be useful for the surgical treatment of these lesions. Some controversies of laser surgery concern the accuracy of pathological diagnosis as well as the control of thermal damage on the target tissue. The aim of this study was to establish if the thermal changes induced by the Nd:YAG laser may affect the histopathological diagnosis and the evaluation of the resection margins. Furthermore, we compared the histological features of oral benign fibro-epithelial lesions excised through Nd:YAG laser and traditional scalpel. Twenty-six benign fibro-epithelial oral lesions from 26 patients, localized in the same oral subsites (cheek and buccal mucosa), were collected at the Unit of Oral Pathology and Oral Laser-assisted Surgery of the Academic Hospital of the University of Parma, Italy. Specimens were subclassified into three groups according to the tool used for the surgical excision. Group 1 included six specimens excised through Nd:YAG laser with an output power of 3.5 W and a frequency of 60 Hz (power density 488,281 W/cm2); Group 2 included nine specimens excised through Nd:YAG laser with an output power of 5 W and a frequency of 30 Hz; Group 3 included 11 specimens excised through a Bard-Parker scalpel blade no. 15c. Epithelial changes, connective tissue modifications, presence of vascular modifications, incision morphology and the overall width of tissue modification were evaluated. Differences between specimens removed with two different parameters of Nd:YAG laser were not significant with regard to stromal changes (p = 0.4828) and vascular stasis (p = 0.2104). Analysis of regularity of incision revealed a difference which was not statistically significant (p = 1.000) between group 1 and group 2. Epithelial and stromal changes were significantly more frequent in specimens with a mean size less than 7 mm (p < 0.0001). Nd:YAG laser induced serious thermal effects in small specimens (mean size less than 7 mm) independently from the frequency and power employed. The quality of incision was better and the width of overall tissue injuries was less in the specimens obtained with higher frequency and lower power (group 1: Nd:YAG laser at 3.5 W and 60 Hz).  相似文献   

11.
This double-masked, randomized controlled trial with a split-mouth design aimed to compare patient- and professional-centered outcomes using different therapeutic approaches—neodymium–yttrium aluminum garnet (Nd:YAG) laser or scalpel technique—for gingival depigmentation. Patients presenting bilateral melanin gingival hyperpigmentation and who requested cosmetic therapy were recruited. Contralateral quadrants were randomly assigned to receive Nd:YAG laser (settings: 6 W, 60 mJ/pulse, and 100 Hz) or scalpel technique. Patient morbidity experienced at intratherapy and during the first postoperative week was evaluated. In addition, after 6 months, the cosmetic results achieved for the different therapeutic approaches were evaluated by patients and professionals. The chair time of each technique was also calculated. Patient-oriented outcomes concerning intratherapy morbidity did not demonstrate any differences between groups (p?>?0.05), although a higher extent of discomfort/pain was experienced in the side treated by the scalpel technique compared to the Nd:YAG laser procedure during the first posttherapy week (p?<?0.05). Regarding to cosmetic outcomes, no differences between techniques were observed for patient and professionals (p?>?0.05). Significantly higher chair time was required for the scalpel technique than for the Nd:YAG laser therapy (p?<?0.05). The Nd:YAG laser or the scalpel technique may be successfully used for the treatment of melanin gingival hyperpigmentation. However, the use of the Nd:YAG laser has presented advantages in terms of less discomfort/pain during the posttherapy period and a reduction of treatment chair time.  相似文献   

12.
Use of the pulsed Nd:YAG laser for intraoral soft tissue surgery.   总被引:1,自引:0,他引:1  
Application of a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was compared to conventional scalpel in dental soft tissue surgery. Two surgery sites on 29 patients were randomly selected and treated. An additional 41 patients were exclusively treated with the Nd:YAG laser. The surgical technique was then evaluated for periodontal pocket depths, degree of pain perceived, bleeding, inflammation, procedure time, and anesthesia. Surgical prognosis was made at the time of surgery and compared to actual healing 1 week and 1 month after surgery. No differences were observed between laser and scalpel surgery in terms of pocket depth reduction, postoperative pain, post-operative inflammation, and treatment time. However, operative and postoperative bleeding with laser surgery were significantly less than with conventional surgery. Anesthesia is required for scalpel surgery, the majority of laser-treated sites evoked minimal pain without anesthesia. These results indicate that the Nd:YAG laser can be used successfully for intraoral soft tissue applications are well tolerated without anesthesia and minimal bleeding compared to scalpel surgery.  相似文献   

13.
A high-powered semiconductor diode laser (805 nm) has recently been developed for medical use. The laser-tissue interactions of this wavelength have been compared with Nd:YAG (1064 nm). When used in the contact mode, the extent of tissue vaporization and zones of thermal necrosis produced by these two lasers were similar. The diode laser was also an effective and haemostatic laser scalpel. This compact laser unit has potential advantages over existing Nd:YAG lasers. © 1992 Wiley-Liss, Inc.  相似文献   

14.
A Cavitron Ultrasonic Surgical Aspirator (CUSA) was used to isolate and skeletonize parenchymal renal vessels during 20 partial nephrectomies performed on 10 dogs. After isolation of the renal vessels, hemostasis was obtained by direct application of neodymium:YAG laser energy. Blood loss and total operative time were reduced compared to a control series of partial nephrectomies performed with a scalpel. The combination of Cavitron Ultrasonic Surgical Aspirator plus a Nd:YAG laser appears to offer advantages compared to either modality used alone or to standard techniques for partial nephrectomy.  相似文献   

15.
The purpose of this study is to determine the role of bleeding, acute thermal damage, and charring in adhesion formation. Postoperative adhesions were compared following ovarian wedge resection in 48 rabbits using different lasers, electrosurgery, and scalpel. Twelve ovaries were sectioned per modality, in randomized pairs. Acute thermal injury as assessed by histology, bleeding, and charring differed amonge the modalities used. Adhesions were assessed 4 weeks later, by an investigator completely blinded of the treatment protocol. The adhesion scores were 11.6 ± 8.0 with pulsed Er:YAG laser; 11.9 ± 7.5 with scalpel; 8.3 ± 9.3 with electrocautery; 6.7 ± 8.8 with a continuous (c.w.) Nd:YAG laser; 5.3 ± 4.8 with c.w. CO2 laser; 3.1 ± 2.7 with pulsed CO2 laser; 1.7 ± 1.8 with pulsed Ho:YAG laser; and 0.8 ± 1.5 in the control (no resection) group. Ho:YAG, Nd:YAG, and electrocautery were completely hemostatic. Bleeding was minimal with the CO2 lasers. Er:YAG and scalpel caused maximum bleeding, requiring hemostatic measures to prevent exanguination. Charring occurred with electrocautery, CO2 laser, and Nd:YAG laser. Bleeding and charring correlated with adhesion formation, but the histological depth of thermal damage did not. The Ho:YAG laser is a hemostatic, fiber-optic compatible laser causing significantly fewer adhesions (P<0.04) than scalpel, electrocautery, Nd:YAG, Er:YAG, and c.w. CO2 lasers. Clinical use of the Ho:YAG laser, and the role of carbonization in promoting adhesions, deserve further study. © 1993 Wiley-Liss, Inc.  相似文献   

16.
This study compares the incidence of local tumor recurrence following primary excision with the CO2 laser, Nd:YAG laser (contact), Argon Beam Coagulator, or electrocautery. One hundred eight Fisher 344 rats with R3230AC mammary tumors (1.6 +/- 0.04 [SD] cm diameter) were used. All animals were randomized into groups of similar tumor size. In groups C and CS, excision was performed with a Sharplan 1060 CO2 laser (TEMoo, 25 W, continuous wave [CW], 0.2-mm spot size). Wounds in group CS were "sterilized" (0.5-mm spot size, 25 W, CW) by gently heating the wound without causing blanching or charring. In group N, a 0.4-mm contact Laser Blade and a Cooper 8000 Nd:YAG laser at 20 W CW was used. In groups SA1 and SA2, tumors were excised with the scalpel, and hemostasis and wound "sterilization" were accomplished with the Bard System 6000 Argon Beam Coagulator (ABC) at 40 W and 4 liters/min argon gas flow in SA1 and 12 liters/min in SA2. In group E, excision was accomplished at 40 W blend mode, 10 W spray mode. In group EA, excision was accomplished at 60 W cutting current, and hemostasis was achieved with the ABC. The animals were examined for evidence of recurrence for 34 days postoperatively. Mortalities were excluded from analysis. The incidence of recurrence was 11/14 (79%) in C, 6/16 (38%) in CS, 10/14 (71%) in SA1, 6/13 (46%) in SA2, 6/15 (40%) in N, 7/10 (70%) in EA, and 3/15 (20%) in E. Group E is statistically different (P less than .01) from groups EA, C, and SA1. Group C was different (P less than .01) from groups E, CS, and N. These results demonstrate an inverse relationship between tumor recurrence and local thermal effects at the surgical site. The ABC did not increase tumor recurrence. Contact YAG surgery was similar to CO2 laser excision and "sterilization." An attempt to study the influence of gas flow and pressure on local tumor recurrence and metastases should be made.  相似文献   

17.
Summary The feasibility and efficacy of laparoscopic CO2 laser and Nd:YAG non-contact laser application for the treatment of polycystic ovarian disease (PCOD) were evaluated in 30 patients (19 patients treated with the CO2 laser, and 11 with the Nd:YAG laser). The criteria for inclusion of PCOD in our study were: amenorrhea or oligomenorrhea with chronic anovulation, failure to ovulate in response to clomide or human menopausal gonadotropin, elevated serum levels of luteinizing hormone (LH) or an elevated LH/follicle-stimulating hormone ratio, exaggerated LH response to gonadotrophin-releasing hormone (GnRH), elevated serum androgen levels, and ultrasonographic features of polycystic ovaries. Eight pregnancies after CO2 laser and three after Nd:YAG laser were achieved. Decline of serum androgen concentrations was noted in both groups, but was significantly higher in the Nd:YAG laser group (from 3.4±0.4 ng/ml to 2.2±0.2 ng/ml). Nine patients checked before and after laser treatment showed a decrease in the characteristically exaggerated pituitary response to exogenous GnRH injection. There were no consistent findings of the pattern in LH pulsatility studied in 5 patients after Nd:YAG laser treatment. Ovarian status was investigated in 11 patients by second-look laparoscopy or cesarian section. There were absolutely no adhesions after Nd:YAG laser coagulation. Filmy adhesions were seen in 3 patients in the CO2 laser group.  相似文献   

18.
This study was designed to compare Nd:YAG laser to fibrin glue, electrocautery, and avitene in the management of superficial splenic injury. Six dogs were submitted to laparotomy. A #11 blade scalpel was used to sharply excise the splenic capsule inflicting four 1″ × 1″ superficial injuries on each spleen. The lesions were treated. All animals had a second laparotomy (“first relaparotomy”); 2 dogs each were reexplored on postop days 3, 7, and 14. Morphologic and histologic observations were made. A third and final relaparotomy was performed on all dogs at 21 days with repeated morphologic and histologic assessments. Hemostatic times, grades of adhesions, and microscopic changes were not significantly different among the various treatments (P > 0.25). Capsular plaque formations were significantly different at the first relaparotomy (P < 0.01) and at final relaparotomy (P < 0.05). Both adhesions and capsular plaque formation were least at fibrin glue-treated sites, whereas Nd:YAG (1.06 μm) was most effective for average hemostatic time (mean = 109.67 s). Electrocautery produced the greatest necrosis at treatment sites. We conclude that all modalities are effective in controlling hemorrhage. © 1994 Wiley-Liss, Inc.  相似文献   

19.
Objective: This experimental study in pigs was undertaken to answer the question whether TMLR after acute myocardial infarction may improve regional myocardial perfusion, left ventricular function and diminish myocardial necrosis in the area at risk. Methods: Thirty open-chest anesthetized pigs were observed for 6 h, six pigs served as controls. In 24 pigs, occlusion of the left anterior descending artery (LAD) beyond the first diagonal branch was performed: seven pigs had LAD occlusion only (ischemia group), and 17 pigs were treated by TMLR (using a CO2-laser, energy: 40 J) prior to coronary occlusion; nine pigs received one laser channel (1 mm diameter) per cm2 (laser group 1) and eight pigs two channels per cm2 in the LAD territory (laser group 2). Regional myocardial blood flow by microspheres, function (franc starling curves), histochemical assessment (triphenyl tetrazolium chloride, TTC and histology), were performed. Results: The lased pigs were less prone to ventricular fibrillation (laser group 2, 38%; laser group 1, 56%; ischemic group, 100%; P<0.05), and showed a significant smaller area of necrosis (TTC) in the area at risk (laser group 1, 23%; laser group 2, 14%; vs. ischemia group, 31%; P<0.01). There was no significant difference between laser-treated and ischemia hearts regarding the amount of blood flow into the infarcted LAD region and the maximal left ventricular stroke work index after 6 h (P=n.s). Regional myocardial blood flow: ischemia group, 4±5 ml/100 g/min; laser group 1, 3±10 ml/100 g/min, and laser group 2, 2±10 ml/100 g/min; maximal left ventricular stroke work index: ischemia group, 1.8 mJ/g; laser group 1, 2.1 mJ/g and laser group 2, 2.1 mJ/g. Conclusions: This model of acute regional ischemia demonstrates that CO2-laser revascularization diminish significantly the incidence of ventricular fibrillation and necrosis in the area at risk, and does not change regional myocardial perfusion and global left ventricular function. This experiment indicates that TMLR may be an alternative in treating advanced ischemic heart disease.  相似文献   

20.
 Interstitial laser thermotherapy (ILTT) was performed increasingly for local destruction of different tumours. The proposal of the present study was the optimisation of the therapy-relevant ILTT parameters and laser application forms which are a prerequisite for the development of an optimal tumour treatment strategy. Laser-induced temperature changes and coagulation patterns with different laser light applicators (bare fibre, ring mode fibre, side fibre, diffuser fibre) were investigated on liver, spleen and tongue tissues of 26 adult pigs after interstitial thermotherapy with Nd: YAG laser. Analysis of experimental results on ILTT and tissue necrosis showed a dependence on laser exposure time, type of laser fibre and applied laser energy. The most homogeneous and extensive coagulation zone was seen after laser treatment with rather low energy over a longer time period. Received: 18 March 2002 / Accepted: 20 August 2002  相似文献   

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