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A novel tool in laryngeal surgery: Preliminary results of the picosecond infrared laser

Authors

  • Arne Böttcher MD,

    Corresponding author
    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
    • Send correspondence to Arne Böttcher, MD, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail: ar.boettcher@uke.de

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    • A. Böttcher and T.S. Clauditz contributed equally to this work and share the first authorship.

  • Till S. Clauditz MD,

    1. Department of Pathology, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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    • A. Böttcher and T.S. Clauditz contributed equally to this work and share the first authorship.

  • Rainald Knecht PhD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Stanislav Kucher DDS,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Wolfgang Wöllmer PhD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Waldemar Wilczak MD,

    1. Department of Pathology, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Peter Krötz MSc,

    1. Atomically Resolved Dynamics Division, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Nathan Jowett MD,

    1. Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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  • Carsten V. Dalchow MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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  • Adrian Münscher MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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    • A. Mönscher and R.J.D. Miller concerning last authorship.

  • R. J. Dwayne Miller PhD

    1. Atomically Resolved Dynamics Division, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
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    • A. Mönscher and R.J.D. Miller concerning last authorship.


  • This study was funded by the European Research Council Advanced Investigator Grant “Miller: ERC-AdG-2011–291630: SUREPIRL, Picosecond Infrared Laser for Scar Free Surgery with Preservation of Tissue Structure and Recognition of Tissue Type and Boundaries.” R. Knecht is a member of the Advisory Boards of Merck Serono; Sanofi Aventis; Boehringer Ingelheim; and Bayer Healthcare, Leverkusen, Germany. R. J. Dwayne Miller is a founder of AttoDyne, Inc. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Conventional lasers ablate tissue through photothermal, photomechanical, and/or photoionizing effects, which may result in collateral tissue damage. The novel nonionizing picosecond infrared laser (PIRL) selectively energizes tissue water molecules using ultrafast pulses to drive ablation on timescales faster than energy transport to minimize collateral damage to adjacent cells.

Study Design

Animal cadaver study.

Methods

Cuts in porcine laryngeal epithelium, lamina propria, and cartilage were made using PIRL and carbon dioxide (CO2) laser. Lateral damage zones and cutting gaps were histologically compared.

Results

The mean widths of epithelial (8.5 μm), subepithelial (10.9 μm), and cartilage damage zones (8.1 μm) were significantly lower for cuts made by PIRL compared with CO2 laser (p < 0.001). Mean cutting gaps in vocal fold (174.7 μm) and epiglottic cartilage (56.3 μm) were significantly narrower for cuts made by PIRL compared with CO2 laser (P < 0.01, P < 0.05).

Conclusion

PIRL ablation demonstrates superiority over CO2 laser in cutting precision with less collateral tissue damage.

Level of Evidence

N/A. Laryngoscope, 123:2770–2775, 2013

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