Resection of the liver with the Nd:YAG laser

Controlled studies of experimental hepatic resection have shown noncontact Nd:YAG techniques to be superior in hepatic resection when compared with conventional finger-fracture or ultrasonic aspirator, although tissue damage was extensive. The noncontact technique is compared with the contact technique of hepatic resection (25 to 30 per cent) in male Wistar rats (n equals 60) using a specially designed artificial sapphire laser scalpel attached to the optic fiber. Contact required only low power ranges (5 to 25 watts) for a rapid hepatic lobe resection associated with less bleeding and smoke. Noncontact resection at low power (10 to 20 watts) caused uncontrollable bleeding leading to death whereas in power density ranges greater than 30 watts, successful resection of a lobe of the liver could be done, but as the power increased, there was greater tissue damage. Light microscopy showed laser penetration of 0.5 to 1.0 millimeters with the contact method with evidence of healing, fibrosis and minimal necrotic material at 15 days. In the noncontact group, laser penetration was 2 to 4 millimeters in depth with accumulated necrotic material encapsulated by fibrous tissue at 15 days. Contact hepatic resection with the laser scalpel offers many new advantages than conventional noncontact Nd:YAG laser techniques.