Potential of a new cw 2 μm laser scalpel for laparoscopic surgery

The potential of a new continuous-wave (cw) thulium–YAG laser for laparoscopic small intestine resection was investigated in pigs in comparison to standard bipolar scissors.

Method

A diode-pumped solid-state thulium–YAG laser system emitting at a wavelength of 2.01 μm was used. Laser power up to 25 W in cw mode was transmitted via a quartz fibre (400 μm core diameter). In order to resect 1 m of the small intestine, the accompanied mesentery was dissected with both devices in 12 pigs (six each group). Arteries and veins of 0.25–3.2 mm inner diameter were dissected in vivo and the resistance of the occluded vessels to pressures up to 375 mmHg was measured by an in vitro set-up. Samples were prepared for histological evaluation.

Results

With respect to intestine resection with bipolar scissors, bleeding occurred significantly less (25%) and dissection time was reduced by 19% using the 2 μm laser scalpel. With the 2 μm laser scalpel, small vessels (<0.5 mm) were successfully occluded up to 100% (arteries) and 89% (veins), larger vessels (1–2.3 mm) to 74% (arteries) and 65% (veins) in vivo. In the in vitro pressure measurement with 375 mmHg, 30% of veins and 35% of arteries stayed closed. In conclusion, the first experiments show that the 2 μm laser scalpel is a promising dissection device for minimally invasive surgery.