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Optimizing Settings for Office-Based Endoscopic CO2 Laser Surgery Using an Experimental Vocal Cord Model.

Anouk S Schimberg1, Tim M Klabbers1, David J Wellenstein1

  • 1Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

The Laryngoscope
|February 6, 2020
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Optimizing flexible endoscopic CO2 laser surgery requires understanding thermal effects. Shorter laser durations and minimal distance to tissue reduce damage, while pulsed modes increase incision depth.

Keywords:
Flexible endoscopic CO2 laserthermal effectsvocal cords

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Area of Science:

  • Biomedical Engineering
  • Surgical Technology
  • Laser Physics

Background:

  • Flexible endoscopic CO2 laser surgery offers precise tissue ablation.
  • Optimizing treatment parameters is crucial to minimize collateral thermal damage.
  • Understanding the thermal effects of individual laser settings is essential for surgical success.

Purpose of the Study:

  • To investigate the thermal effects of various CO2 laser settings on target tissues.
  • To optimize flexible endoscopic CO2 laser surgery treatment parameters.
  • To evaluate the impact of emission mode, power, distance, and duration on thermal spread and incision depth.

Main Methods:

  • Utilized a color Schlieren technique with a polyacrylamide gel model to visualize CO2 laser thermal effects.
  • Varied laser emission mode, power, fiber distance, and duration in all combinations.
  • Measured collateral thermal expansion and incision depth, validating with ex vivo human vocal cord histology.

Main Results:

  • Laser irradiation duration significantly influenced thermal expansion.
  • Increased laser tip-to-tissue distance reduced incision depth but increased thermal expansion.
  • Pulsed emission modes resulted in deeper incisions, while the model showed fair correlation with ex vivo vocal cord data.

Conclusions:

  • High-intensity pulsed lasers at minimal distance minimize exposure time and surrounding tissue damage.
  • Evaporation techniques with lower power, continuous wave, and greater distance yield superficial, broader thermal effects.
  • The developed model is a valid tool for studying laser-induced thermal effects in vocal cord tissue.