Laser probes for noninvasive coagulation of subsurface tissues

Previous ex vivo tissue studies utilizing deep laser heating combined with contact cooling of the tissue surface produced noninvasive thermal destruction of subsurface tissue structures in skin and liver samples. This study describes the design and preliminary in vivo testing of two integrated laser/cooling probes for simultaneous Nd:YAG laser irradiation and sapphire contact cooling of liver and skin tissues in an in vivo, acute porcine model for potential use in laparoscopic and endoscopic surgery. Nd:YAG laser radiation with a wavelength of 1.06 μm, power of 20 W, 7.5-mm-diameter spot, 500-ms pulse length, and repetition rate of 0.625 Hz, was delivered to the tissue with a total irradiation time of 16 s. The tissue surface was continuously cooled with a sapphire plate maintained at - 5°C, and with pre- and post-ablation cooling times measuring 120 s and 30 s, resulting in a total operation time of 166 s per a lesion. Thermal lesions were created in liver and skin at a 1-mm depth below the tissue surface and with a 3-4 mm diameter. The laser parameters and lesion dimensions were comparable to previous ex vivo tissue studies. Preliminary in vivo animal studies demonstrate noninvasive creation of subsurface thermal lesions in tissue using Nd:YAG laser irradiation in conjunction with sapphire contact cooling. Chronic wound healing studies will be necessary to optimize the laser and cooling parameters. Potential clinical applications include endoscopic laser treatment of female stress urinary incontinence and thermal coagulation of early stage bladder tumors.