The True Ablation Effect of Holmium YAG Laser on Soft Tissue

The holmium YAG (Ho:YAG) laser penetration depth (PD) of 0.4 mm has been widely described. Nonetheless, in physics, this concept refers to the tissue thickness at which 90% of the energy has been absorbed and not to the incision depth (ID) that the laser can achieve in tissue. The aim of this study is to evaluate the ablation efficiency of Ho:YAG laser on soft tissue.

With an automated robotic arm, systematic fissures were performed on flat veal kidney specimens. Broad setting spectrums from 2.5 to 80 W, short and long pulse, were tested with 272 and 365 μm laser fibers. Experiments were repeated three times. Two pathologists in a blinded manner measured the width, depth, and coagulation area with electronic microscopy.

The overall mean ID was 2 mm (0.25-4.39) and the mean width was 1 mm (0.3-3.1). The mean coagulation thickness was 0.48 mm (0.25-1.73). The higher the frequency and energy, the deeper and wider was the incision p < 0.001. No differences were observed regarding the fiber diameter. The pulse length did not affect the ID, although the mean width was greater with short pulse p = 0.04. The outer mean coagulation was increased by increasing energy but not by increasing frequency p > 0.119.

The overall mean ID was significantly higher than the theoretical 0.4 mm PD described for Ho:YAG laser. The energy, frequency, and pulse length had individual effects regarding ID, incision width, and coagulation. The ID should be specified in accordance with the laser's power output and should not be confused with the physics of PD concept.