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Nitesh Katta¹, Arnold D Estrada², Austin B McElroy²

¹Beckman Laser Institute, University of California at Irvine, East Irvine, California, USA.

Lasers in Surgery and Medicine

|August 10, 2022

Summary

This study introduces a vascular-specific ytterbium (Yb) fiber-laser for enhanced photocoagulation in neurosurgery. The Yb/Er:YAG laser system improves precision in Erbium:YAG tissue resection, minimizing thermal spread and ensuring a bloodless surgical field.

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Editorial Comment.

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Area of Science:

Neurosurgery
Biomedical Engineering
Laser Medicine

Background:

Erbium:yttrium-aluminum-garnet (Er:YAG) lasers effectively resect water-bearing tissues but cause unpredictable bleeding in neurosurgery.
Previous dual-wavelength systems using thulium (Tm) fiber-lasers for coagulation showed limited vascular specificity and significant lateral thermal spread.
Optical coherence tomography (OCT) has been used for guidance in laser tumor resection.

Purpose of the Study:

To develop and evaluate a vascular-specific ytterbium (Yb) fiber-laser for enhanced photocoagulation during neurosurgery.
To improve the precision of Er:YAG tissue resection by minimizing lateral thermal spread.
To compare the efficacy of Yb/Er:YAG laser surgery with Tm/Er:YAG laser surgery for hemostasis and tissue ablation.

Main Methods:

Keywords:

Er:YAG Yb fiber-laser brain laser surgery neurosurgery

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Stereotactic laser surgery was performed on mice using a Yb/Er:YAG dual-wavelength system.
Optical coherence tomography (OCT) and OCT-derived angiography were used for real-time imaging, vessel coagulation confirmation, and guiding Er:YAG resection.
Histological analysis (H&E and Nissl staining) was conducted to compare lateral thermal spread with a previously reported Tm/Er:YAG system.

Main Results:

The Yb fiber-laser effectively achieved hemostasis in various blood vessel sizes in murine brains.
Histological analysis revealed significantly lower lateral thermal spread with the Yb/Er:YAG system compared to the Tm/Er:YAG system.
The Yb/Er:YAG system maximized hemostasis and tissue ablation efficiency while minimizing thermal damage.

Conclusions:

A vascular-specific coagulation scheme using Yb/Er:YAG dual-wavelength laser surgery was successfully demonstrated for neurosurgery.
The Yb/Er:YAG system offers improved coagulation, reduced thermal damage, and limited lateral thermal spread compared to Tm/Er:YAG systems.
The developed dual-wavelength laser system enables precise neural tissue resection with minimal thermal spread and a bloodless surgical field.