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- Title
Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral thermal injury in comparison to superpulsed CO laser.
- Authors
Böttcher, Arne; Jowett, Nathan; Kucher, Stanislav; Reimer, Rudolph; Schumacher, Udo; Knecht, Rainald; Wöllmer, Wolfgang; Münscher, Adrian; Dalchow, Carsten
- Abstract
Despite causing significant thermocoagulative insult, use of the carbon dioxide (CO) laser is considered gold standard in surgery for early stage larynx carcinoma. Limited attention has been paid to the use of the erbium:yttrium-aluminium-garnet (Er:YAG) laser in laryngeal surgery as a means to reduce thermal tissue injury. The objective of this study is to compare the extent of thermal injury and precision of vocal fold incisions made using microsecond Er:YAG and superpulsed CO lasers. In the optics laboratory ex vivo porcine vocal folds were incised using Er:YAG and CO lasers. Lateral epithelial and subepithelial thermal damage zones and cutting gap widths were histologically determined. Environmental scanning electron microscopy (ESEM) images were examined for signs of carbonization. Temperature rise during Er:YAG laser incisions was determined using infrared thermography (IRT). In comparison to the CO laser, Er:YAG laser incisions showed significantly decreased epithelial (236.44 μm) and subepithelial (72.91 μm) damage zones ( p < 0.001). Cutting gaps were significantly narrower for CO (878.72 μm) compared to Er:YAG (1090.78 μm; p = 0.027) laser. ESEM revealed intact collagen fibres along Er:YAG laser cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO laser incisions. IRT demonstrated absolute temperature rise below 70 °C for Er:YAG laser incisions. This study has demonstrated significantly reduced lateral thermal damage zones with wider basal cutting gaps for vocal fold incisions made using Er:YAG laser in comparison to those made using CO laser.
- Subjects
LARYNGEAL surgery; LARYNGEAL diseases; YAG lasers; ELECTRON microscopy; THERMOGRAPHY; HISTOLOGY
- Publication
European Archives of Oto-Rhino-Laryngology, 2014, Vol 271, Issue 5, p1121
- ISSN
0937-4477
- Publication type
Article
- DOI
10.1007/s00405-013-2761-0