Abstract：
OBJECTIVE: To assess laser-tissue interactions through ablation, coagulation, and carbonisation characteristics in a non-perfused porcine kidney model between three pulsed lasers: holmium (Ho): yttrium-aluminium-garnet (YAG), thulium fiber laser (TFL), and pulsed thulium (p-Tm):YAG.
METHODS: A 150-W Ho:YAG, a 60-W TFL, and a 100-W p-Tm:YAG lasers were compared. The laser settings that can be set identically between the three lasers and be clinically relevant for prostate laser enucleation were identified and used on fresh, unfrozen porcine kidneys. Laser incisions were performed using stripped laser fibers of 365 and 550 μm, set at distances of 0 and 1 mm from the tissue surface at a constant speed of 2 mm/s. Histological analysis evaluated shape, depth, width of the incision, axial coagulation depth, and presence of carbonisation.
RESULTS: Incision depths, widths, and coagulation zones were greater with Ho:YAG and p-Tm:YAG lasers than TFL. Although no carbonisation was found with the Ho:YAG and p-Tm:YAG lasers, it was common with TFL, especially at high frequencies. The shapes of the incisions and coagulation zones were more regular and homogeneous with the p-Tm:YAG laser and TFL than with Ho:YAG laser. Regardless of the laser used, short pulse durations resulted in deeper incisions than long pulse durations. Concerning the distance, we found that to be effective, TFL had to be used in contact with the tissue. Finally, 365-μm fibers resulted in deeper incisions, while 550-μm fibers led to wider incisions and larger coagulation zones.
CONCLUSIONS: Histological analysis revealed greater tissue penetration with the p-Tm:YAG laser compared to the TFL, while remaining less than with Ho:YAG. Its coagulation properties seem interesting insofar as it provides homogeneous coagulation without carbonisation, while incisions remained uniform without tissue laceration. Thus, the p-Tm:YAG laser appears to be an effective alternative to Ho:YAG and TFL lasers in prostate surgery.
METHODS: A 150-W Ho:YAG, a 60-W TFL, and a 100-W p-Tm:YAG lasers were compared. The laser settings that can be set identically between the three lasers and be clinically relevant for prostate laser enucleation were identified and used on fresh, unfrozen porcine kidneys. Laser incisions were performed using stripped laser fibers of 365 and 550 μm, set at distances of 0 and 1 mm from the tissue surface at a constant speed of 2 mm/s. Histological analysis evaluated shape, depth, width of the incision, axial coagulation depth, and presence of carbonisation.
RESULTS: Incision depths, widths, and coagulation zones were greater with Ho:YAG and p-Tm:YAG lasers than TFL. Although no carbonisation was found with the Ho:YAG and p-Tm:YAG lasers, it was common with TFL, especially at high frequencies. The shapes of the incisions and coagulation zones were more regular and homogeneous with the p-Tm:YAG laser and TFL than with Ho:YAG laser. Regardless of the laser used, short pulse durations resulted in deeper incisions than long pulse durations. Concerning the distance, we found that to be effective, TFL had to be used in contact with the tissue. Finally, 365-μm fibers resulted in deeper incisions, while 550-μm fibers led to wider incisions and larger coagulation zones.
CONCLUSIONS: Histological analysis revealed greater tissue penetration with the p-Tm:YAG laser compared to the TFL, while remaining less than with Ho:YAG. Its coagulation properties seem interesting insofar as it provides homogeneous coagulation without carbonisation, while incisions remained uniform without tissue laceration. Thus, the p-Tm:YAG laser appears to be an effective alternative to Ho:YAG and TFL lasers in prostate surgery.
摘要：
目的：通过消融评估激光与组织的相互作用，凝血,在三个脉冲激光之间的非灌注猪肾脏模型中的碳化特性：钬（Ho）：钇铝石榴石（YAG），碲光纤激光器(TFL),和脉冲（p-Tm）：YAG。
方法：150-WHo:YAG，60WTFL,和100Wp-Tm：YAG激光器进行了比较。可以在三个激光器之间相同地设置并且与前列腺激光摘除临床相关的激光设置被识别并用于新鲜的，未冷冻的猪肾.使用365和550μm的剥离激光纤维进行激光切口，以2mm/s的恒定速度设置在距组织表面0和1mm的距离处。组织学分析评估形状，深度,切口的宽度，轴向凝固深度,和碳化的存在。
结果：切口深度，宽度,Ho：YAG和p-Tm：YAG激光的凝固区大于TFL。尽管Ho：YAG和p-Tm：YAG激光器没有发现碳化，这与TFL很常见，尤其是在高频。p-Tm：YAG激光和TFL的切口和凝固区的形状比Ho：YAG激光的更规则和均匀。不管使用何种激光,短脉冲持续时间导致比长脉冲持续时间更深的切口。关于距离,我们发现要有效，TFL必须与组织接触使用。最后,365-μm纤维导致更深的切口，而550μm纤维导致更宽的切口和更大的凝结区。
结论：组织学分析显示，与TFL相比，p-Tm:YAG激光的组织穿透性更大，而剩下的比Ho:YAG少。它的凝固特性似乎很有趣，因为它提供了均匀的凝固而没有碳化，切口保持均匀，无组织撕裂。因此，在前列腺手术中，p-Tm：YAG激光似乎是Ho：YAG和TFL激光的有效替代方法。
方法：150-WHo:YAG，60WTFL,和100Wp-Tm：YAG激光器进行了比较。可以在三个激光器之间相同地设置并且与前列腺激光摘除临床相关的激光设置被识别并用于新鲜的，未冷冻的猪肾.使用365和550μm的剥离激光纤维进行激光切口，以2mm/s的恒定速度设置在距组织表面0和1mm的距离处。组织学分析评估形状，深度,切口的宽度，轴向凝固深度,和碳化的存在。
结果：切口深度，宽度,Ho：YAG和p-Tm：YAG激光的凝固区大于TFL。尽管Ho：YAG和p-Tm：YAG激光器没有发现碳化，这与TFL很常见，尤其是在高频。p-Tm：YAG激光和TFL的切口和凝固区的形状比Ho：YAG激光的更规则和均匀。不管使用何种激光,短脉冲持续时间导致比长脉冲持续时间更深的切口。关于距离,我们发现要有效，TFL必须与组织接触使用。最后,365-μm纤维导致更深的切口，而550μm纤维导致更宽的切口和更大的凝结区。
结论：组织学分析显示，与TFL相比，p-Tm:YAG激光的组织穿透性更大，而剩下的比Ho:YAG少。它的凝固特性似乎很有趣，因为它提供了均匀的凝固而没有碳化，切口保持均匀，无组织撕裂。因此，在前列腺手术中，p-Tm：YAG激光似乎是Ho：YAG和TFL激光的有效替代方法。
