Surgical utility of a new carbon dioxide laser fiber: Functional and histological study

Objectives/Hypothesis. The objective was to investigate the functional and histological properties of surgical procedures using a new carbon dioxide (CO2) laser fiber. Study Design: In vitro and in vivo animal models. Methods. In vitro experiments using porcine true vocal cord and arytenoid cartilage were designed to study the histological effects of using a photonic band-gap fiber assembly for CO2 laser energy delivery. Continuous and pulsed-wave settings at different wattages were tested. In vivo endoscopic surgery on canine larynges and buccal mucosa were performed to examine functional and short-term healing when performing photonic band-gap fiber assembly-assisted laser surgery. Results. In vitro experiments showed consistent cutting with the photonic bandgap fiber assembly using either straight or 90 degrees bent-tip fibers. The surrounding tissue in these experiments showed little collateral thermal damage with the average range of thermal width from 14.1 to 18.8 mu m in vocal cords and from 5.2 to 10.5 mu m in cartilage. Similarly, thermal depth ranged from 28.0 to 350.0 mu m in vocal cords and from 269.7 to 739.6 mu m in cartilage. In vivo experiments demonstrated ease in maneuvering and flexibility for cutting. There was minimal blood loss, smoke plume, or carbonaceous debris. There were no postprocedural complications. Normal oral intake was noted on postprocedural day 1. There was no evidence of stridor or respiratory distress. Seven days after the procedure, re-epithelialization was complete in the buccal incisions and nearly completed in the laryngeal incisions. Conclusion: The photonic band-gap fiber assembly produced reliable results in cutting with functional characteristics representing an improvement over current technology. The device shows promise as an effective tool for minimally invasive procedures that are amenable to use of the CO2 laser.