Comparison of fiber-optic linear beam shaping designs for laparoscopic laser sealing of vascular tissues

Infrared lasers may provide faster and more precise sealing of blood vessels and with lower device jaw temperatures than ultrasonic and electrosurgical devices during surgery. Our study explores three beam shaping methods using optical fibers for transformation of a circular laser beam into a linear beam, necessary for integration into a standard 5-mm-diameter laparoscopic device, and for uniform irradiation perpendicular to the vessel length. In the first design, a servo motor connected to a side-firing, 550-μm-core fiber, provided linear translation of a 2.0-mm-diameter circular beam, back, and forth, over either 5 or 11 mm scan lengths for sealing of small or large vessels. The second design used external beam splitters to divide laser power equally into three side-firing fibers, stacked side-by-side, producing a linear beam of 4 × 2 mm. The third design used external beam splitters with three forward-firing fibers and a slanted jaw surface, to produce a linear beam of 5 × 1.5 mm. Laser seals were performed, ex vivo, on 41 porcine renal arteries of 1- to 6-mm diameter (n ≥ 10 samples for each design). Each vessel was compressed to a fixed 0.4-mm-thickness, matching the optical penetration depth at 1470 nm. Vessels were irradiated with fluences of 636 to 800 J/cm², which, based on previous studies, is sufficient for sealing, but not cutting. A burst pressure setup was used to evaluate vessel seal strength. Reciprocating fiber and fiber bundles produced mean burst pressures of 554 ± 142, 524 ± 132, 429 ± 99, and 390 ± 140 mmHg, respectively. All designs consistently sealed blood vessels, with burst pressures above hypertensive (180 mmHg) blood pressures. The reciprocating fiber produced the most uniform linear beam profile and aspect ratio but will require integration of the servo motor into a handpiece. Fiber bundle designs produced shorter, less uniform beams, but enable optical components to be assembled outside the handpiece.