Optimization of the Erbium:YAG laser for precise incision of ureteral and urethral tissues: in vitro and in vivo results.
Optimization of the Erbium:YAG laser for precise incision of ureteral and urethral tissues: in vitro and in vivo results.
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优化铒:YAG 激光精确切割输尿管和尿道组织：体外和体内结果。
DOI：
10.1002/lsm.10205
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
Hejazi,Pooya
中科院分区：
文献类型：
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作者：
Fried,NathanielM;Tesfaye,Zelalem;Ong,AlbertM;Rha,KoonH;Hejazi,Pooya
背景和目的在内窥镜下治疗输尿管狭窄的过程中，损伤可能会导致狭窄复发。Er：YAG激光消融软组织，周边损伤最小，有望替代冷刀和Ho：YAG激光精密切割泌尿系狭窄。研究设计/材料与方法以猪输尿管和犬尿路组织为实验材料，对Er：YAG激光进行了优化。初步的活体研究也在一个有外露输尿管的腹腔镜猪输尿管模型中进行。激光波长2.94μm，脉冲长度8，70,220微秒，输出能量2~35 mJ，能量1~25 J/cm~2，脉冲重复频率5~30 Hz。结果实验测得的穿孔阈值为2~4 J/cm~2，消融速率为50μm/脉冲，能量为6~11 J/cm~2。活体穿孔阈值约为1.8J/cm2，输尿管穿孔次数少于20次，注量大于3.6J/cm2。当激光脉冲长度从2 2 0微秒减小到8微秒时，组织的周边热损伤从30~60μm减少到10~20μm。结论Er：∼激光脉冲宽度为70微秒，能量大于∼4J/cm2，重复频率小于20 Hz，能快速切割输尿管组织，且热和机械副作用小。激光外科医生。33：108-114,2003。©2003 Wiley-Liss公司
Background and ObjectivesTissue damage during endoscopic treatment of urethral and ureteral strictures may result in stricture recurrence. The Erbium:YAG laser ablates soft tissues with minimal peripheral damage and may be a promising alternative to cold knife and Holmium:YAG laser for precise incision of urological strictures.Study Design/Materials and MethodsOptimization of the Er:YAG laser was conducted using ex vivo porcine ureteral and canine urethral tissues. Preliminary in vivo studies were also performed in a laparoscopic porcine ureteral model with exposed ureter. Laser radiation with a wavelength of 2.94 μm, pulse lengths of 8, 70, and 220 micro seconds, output energies of 2–35 mJ, fluences of 1–25 J/cm2, and pulse repetition rates of 5–30 Hz, was delivered through 250‐μm and 425‐μm core germanium oxide optical fibers in direct contact with tissue.ResultsEx vivo perforation thresholds measured 2–4 J/cm2, with ablation rates of 50 μm/pulse at fluences of 6–11 J/cm2. In vivo perforation thresholds were approximately 1.8 J/cm2, with the ureter perforated in less than 20 pulses at fluences greater than 3.6 J/cm2. Peripheral thermal damage in tissue decreased from 30 to 60 μm to 10–20 μm as the laser pulse length decreased from 220 to 8 microseconds. Mechanical tissue damage was observed at the 8 microseconds pulse duration.ConclusionsThe Er:YAG laser, operating at a pulse duration of ∼70 microseconds, a fluence greater than ∼4 J/cm2, and a repetition rate less than 20 Hz, is capable of rapidly incising urethral and ureteral tissues with minimal thermal and mechanical side‐effects. Lasers Surg. Med. 33:108–114, 2003. © 2003 Wiley‐Liss, Inc.