Irrigation eliminates smoke formation in laser laparoscopic surgery: ex vivo results

To evaluate the desmoke effects of irrigation on surgical smoke generated during laser laparoscopic surgery using ex vivo model.

A hand-piece was devised as both an irrigation tube and a laser fiber holder. The laser system used was a diode pumped continuous wave Thulium YAG laser (Lisa laser products OHG, Katlenburg-Lindau, Germany) emitting at 2.01-mum through a quartz fiber with a core diameter of 365 mum. Using a transparent container as experimental model (approximately 3 L in volume), 6 irrigation rates (0, 20, 40, 60, 80, and 100 mL/min) were tested combining with 4 laser power settings (20, 30, 40, and 50 W). To evaluate the desmoke efficiency of irrigation, lasing time with effective visibility under different combination of irrigation rates and laser powers were documented, and corresponding smoke generation rate were calculated (=3 L/lasing time). Analysis of variance was used to compare difference and significance was indicated at P<0.05.

Calculated smoke generation rate was increased with laser power whereas decreased with irrigation rate. At 4 tested laser powers, calculated smoke generation rates were high (mean: 91.4 to 306.6 mL/s) when no water presented, but were significantly decreased (mean: 12.6 to 55.0 mL/s, P<0.001) with the lowest water flow rate (20 mL/min) and further decreased with higher rates. The proper range of irrigation rate for future clinical practice would be around 40 mL/min.

Irrigation eliminates smoke formation accompanying laser tissue irradiation. It shows promise for future application in laser laparoscopic surgery.