Potential of a new cw 2 μm laser scalpel for laparoscopic surgery

The potential of a new continuous-wave (cw) thulium-YAG laser for laparoscopic small intestine resection was investigated in pigs in comparison to standard bipolar scissors. Method: A diode-pumped solid-state thulium-YAG laser system emitting at a wavelength of 2.01 μm was used. Laser power up to 25 W in cw mode was transmitted via a quartz fibre (400 μm core diameter). In order to resect 1 m of the small intestine, the accompanied mesentery was dissected with both devices in 12 pigs (six each group). Arteries and veins of 0.25-3.2 mm inner diameter were dissected in vivo and the resistance of the occluded vessels to pressures up to 375 mmHg was measured by an in vitro set-up. Samples were prepared for histological evaluation. Results: With respect to intestine resection with bipolar scissors, bleeding occurred significantly less (25%) and dissection time was reduced by 19% using the 2 μm laser scalpel. With the 2 μm laser scalpel, small vessels (<0.5 mm) were successfully occluded up to 100% (arteries) and 89% (veins), larger vessels (1-2.3 mm) to 74% (arteries) and 65% (veins) in vivo. In the in vitro pressure measurement with 375 mmHg, 30% of veins and 35% of arteries stayed closed. In conclusion, the first experiments show that the 2 μm laser scalpel is a promising dissection device for minimally invasive surgery.