A 2-mu m Continuous-Wave Laser System for Safe and High-Precision Dissection During NOTES Procedures

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

来源：Digestive Diseases and Sciences, 2010, 55(9): 2463-2470.

DOI：10.1007/s10620-010-1214-5

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

Introduction Lasers 2-mu m in wavelength offer efficient tissue cutting with limited thermal damage in biological tissue.
Objective To evaluate the dissection capabilities of a 2-mu m 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 maneuver-ability, clean and rapid cutting, and excellent hemostasis. Peritoneoscopy and necropsy showed no damage of targeted tissue and surrounding organs.
Conclusions The 2-mu m continuous-wave laser system showed promising capabilities for highly precise and safe dissection during NOTES procedures.

• 出版日期2010-9