A 2-μm continuous-wave laser system for safe and high-precision dissection during NOTES procedures

Xavier Dray, Gianfranco Donatelli, Devi Mukkai Krishnamurty, Elena Dubcenco, Ronald J. Wroblewski, Lia Assumpcao, Samuel A. Giday, Jonathan M. Buscaglia, Eun J. Shin, Priscilla Magno, Laurie J. Pipitone, Michael R. Marohn, Sergey V. Kantsevoy, Anthony N. Kalloo

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Lasers 2-μm in wavelength offer efficient tissue cutting with limited thermal damage in biological tissue. Objective: To evaluate the dissection capabilities of a 2-μm continuous-wave laser for NOTES procedures. Methods and Procedures: We conducted 18 acute animal experiments. Group 1 (three animals): transcolonic access to the peritoneal cavity (15-W transcolonic laser puncture, balloon dilation over the laser probe). Group 2 (six animals): transcolonic access with needle-knife puncture and balloon dilation. Group 3 (three animals): transgastric access to the peritoneal cavity (similar technique as group 1) followed by laser-assisted dissection of the kidney. In one animal of group 3, a therapeutic target (hematoma) was created by percutaneous puncture of the kidney. Group 4 (six animals): transgastric access (similar to the technique of group 2). Results: Translumenal access to the peritoneal cavity was achieved in 2-3 min in group 1 (significantly shorter than with the needle-knife-assisted technique, 4-5 min, p = 0.02) and in 7-10 min in group 3 (compared to 6-17 min in group 4, p = 0.88). In group 3, laser dissection of the parietal peritoneum and of perinephric connective tissue allowed access to the retroperitoneum with complete removal of a blood collection in the animal with puncture trauma. Laser dissection demonstrated good maneuverability, clean and rapid cutting, and excellent hemostasis. Peritoneoscopy and necropsy showed no damage of targeted tissue and surrounding organs. Conclusions: The 2-μm continuous-wave laser system showed promising capabilities for highly precise and safe dissection during NOTES procedures.

Original languageEnglish (US)
Pages (from-to)2463-2470
Number of pages8
JournalDigestive diseases and sciences
Volume55
Issue number9
DOIs
StatePublished - Sep 2010

Keywords

  • Interventional endoscopy
  • Laser
  • Natural orifice translumenal endoscopic surgery (NOTES)

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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