Combination of fiber-guided pulsed erbium and holmium laser radiation for tissue ablation under water.

Because of the high absorption of near-infrared laser radiation in biological tissue, erbium lasers and holmium lasers emitting at 3 and 2 µm, respectively, have been proven to have optimal qualities for cutting or welding and coagulating tissue. To combine the advantages of both wavelengths, we realized a multiwavelength laser system by simultaneously guiding erbium and holmium laser radiation by means of a single zirconium fluoride (ZrF(4)) fiber. Laser-induced channel formation in water and poly(acrylamide) gel was investigated by the use of a time-resolved flash-photography setup, while pressure transients were recorded simultaneously with a needle hydrophone. The shapes and depths of vapor channels produced in water and in a submerged gel after single erbium and after combination erbium-holmium radiation delivered by means of a 400-µm ZrF(4) fiber were measured. Transmission measurements were performed to determine the amount of pulse energy available for tissue ablation. The effects of laser wavelength and the delay time between pulses of different wavelengths on the photomechanical and photothermal responses of meniscal tissue were evaluated in vitro by the use of histology. It was observed that the use of a short (200-µs, 100-mJ) holmium laser pulse as a prepulse to generate a vapor bubble through which the ablating erbium laser pulse can be transmitted (delay time, 100 µs) increases the cutting depth in meniscus from 450 to 1120 µm as compared with the depth following a single erbium pulse. The results indicate that a combination of erbium and holmium laser radiation precisely and efficiently cuts tissue under water with 20-50-µm collateral tissue damage.

[1]  Martin Frenz,et al.  Influence of pulse duration on erbium and holmium laser ablation under water , 1995, Other Conferences.

[2]  T. Tomaru,et al.  Comparison of ablation efficacy of excimer, pulsed-dye, and holmium-YAG lasers relevant to shock waves. , 1992, American heart journal.

[3]  Yuji Matsuura,et al.  Dielectric-coated metallic hollow waveguide for 3-microm Er:YAG, 5-microm CO, and 10.6-,microm CO(2) laser light transmission. , 1990, Applied optics.

[4]  T J Flotte,et al.  Er:YAG laser ablation of tissue: Effect of pulse duration and tissue type on thermal damage , 1989, Lasers in surgery and medicine.

[5]  G. Delacretaz,et al.  Acoustic transient generation by holmium‐laser‐induced cavitation bubbles , 1994 .

[6]  S. Tuft,et al.  Studies of laser-induced cavitation and tissue ablation in saline using a fibre-delivered pulsed HF laser , 1993 .

[7]  Thomas Jansen,et al.  Holmium laser ablation of cartilage: effects of cavitation bubbles , 1995, Photonics West.

[8]  N. Nishioka,et al.  Pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser ablation of fibrocartilage and articular cartilage , 1990, The American journal of sports medicine.

[9]  Martin Frenz,et al.  Dynamics of laser-induced channel formation in water and influence of pulse duration on the ablation of biotissue under water with pulsed erbium-laser radiation , 1994 .

[10]  J. Walsh,et al.  Er:YAG laser ablation of tissue: Measurement of ablation rates , 1989, Lasers in surgery and medicine.

[11]  A J Welch,et al.  Effect of pulse duration on bubble formation and laser‐induced pressure waves during holmium laser ablation , 1996, Lasers in surgery and medicine.

[12]  R. Salathé,et al.  Fragmentation process induced by microsecond laser pulses during lithotripsy , 1992 .

[13]  T G van Leeuwen,et al.  Origin of arterial wall dissections induced by pulsed excimer and mid-infrared laser ablation in the pig. , 1992, Journal of the American College of Cardiology.

[14]  B. A. Mikhailov,et al.  Dispersion and Absorption of Liquid Water in the Infrared and Radio Regions of the Spectrum , 1969 .

[15]  S L Jacques,et al.  Laser-tissue interactions. Photochemical, photothermal, and photomechanical. , 1992, The Surgical clinics of North America.

[16]  Martin Frenz,et al.  Bone microsurgery with IR lasers: a comparative study of thermal action at different wavelengths , 1994, Other Conferences.

[17]  R. Hibst,et al.  Pulsed 2‐94‐μm erbium–YAG laser skin ablation—experimental results and first clinical application , 1990, Clinical and experimental dermatology.

[18]  Ulrich Parlitz,et al.  Minimization of cavitation effects in pulsed laser ablation illustrated on laser angioplasty , 1996 .

[19]  E. Dreher,et al.  Effects of various laser types and beam transmission methods on female organ tissue in the pig: An in vitro study , 1994, Lasers in surgery and medicine.

[20]  R Birngruber,et al.  Mechanisms of intraocular photodisruption with picosecond and nanosecond laser pulses , 1994, Lasers in surgery and medicine.

[21]  Martin Frenz,et al.  Acoustic transients in pulsed holmium laser ablation: effects of pulse duration , 1995, Other Conferences.

[22]  Martin Frenz,et al.  Infrared multiwavelength laser system for establishing a surgical delivery path through water , 1995 .

[23]  A. Welch,et al.  LASER THERMAL ABLATION , 1991, Photochemistry and photobiology.

[24]  Y. Mimura,et al.  Stress-induced refractive index inhomogeneity in fluoride glass fibers: origin of wavelength independent scattering loss. , 1990, Applied optics.

[25]  A L McKenzie,et al.  An extension of the three-zone model to predict depth of tissue damage beneath Er:YAG and Ho:YAG laser excisions. , 1989, Physics in medicine and biology.

[26]  Martin Frenz,et al.  Thermal and mechanical damage of corneal tissue after free-running and Q-switched mid-infrared laser ablation , 1994, Other Conferences.

[27]  H P Weber,et al.  Temperature and pressure effects during erbium laser stapedotomy , 1996, Lasers in surgery and medicine.

[28]  V. Romano,et al.  Lateral thermal damage along pulsed laser incisions , 1990, Lasers in surgery and medicine.

[29]  W. Grundfest,et al.  Tissue ablation through water with erbium: YAG lasers , 1992, IEEE Transactions on Biomedical Engineering.

[30]  M W Berns,et al.  Ablation of bone and methacrylate by a prototype mid‐infrared erbium:YAG laser , 1988, Lasers in surgery and medicine.

[31]  A J Welch,et al.  Temperature dependence of the absorption coefficient of water for midinfrared laser radiation , 1994, Lasers in surgery and medicine.

[32]  James A. Harrington Laser power delivery in infrared fiber optics (Invited Paper) , 1992, Photonics West - Lasers and Applications in Science and Engineering.

[33]  Martin Frenz,et al.  Transient photoacoustic effects induced in liquids by pulsed erbium lasers , 1994, SPIE LASE.

[34]  T. Katterschafka,et al.  Erb:YAG and Hol:YAG Laser Osteotomy: The Effect of Laser Ablation on Bone Healing , 1994, Lasers in surgery and medicine.

[35]  Werner Lauterborn,et al.  Acoustic transient generation by laser‐produced cavitation bubbles near solid boundaries , 1988 .

[36]  Thomas J. Flotte,et al.  Laser-induced shock wave effects on red blood cells , 1991, Photonics West - Lasers and Applications in Science and Engineering.

[37]  Martin Frenz,et al.  Mechanism of channel propagation in water by pulsed erbium laser radiation , 1994, Other Conferences.

[38]  Reginald Birngruber,et al.  Determination of the shock-wave pressures generated by laser-induced breakdown in water , 1990, Photonics West - Lasers and Applications in Science and Engineering.

[39]  V. Romano,et al.  Fibre-end micro-lens system for endoscopic erbium-laser surgery applications , 1994 .

[40]  D. Choy,et al.  Laser radiation at various wavelengths for decompression of intervertebral disk. Experimental observations on human autopsy specimens. , 1991, Clinical orthopaedics and related research.

[41]  J. Seifert,et al.  The mechanisms of stone disintegration by shock waves. , 1991, Ultrasound in medicine & biology.

[42]  S. Shapshay,et al.  Soft tissue effects of the holmium-YSGG laser in the canine trachea , 1990, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[43]  V. Romano,et al.  A comparative study of laser tissue interaction at 2.94 μm and 10.6 μm , 1988 .

[44]  T G van Leeuwen,et al.  Intraluminal Vapor Bubble Induced by Excimer Laser Pulse Causes Microsecond Arterial Dilation and Invagination Leading to Extensive Wall Damage in the Rabbit , 1993, Circulation.

[45]  I. Gannot,et al.  Flexible waveguides for Er-YAG laser radiation delivery , 1995, IEEE Transactions on Biomedical Engineering.

[46]  T G van Leeuwen,et al.  Noncontact tissue ablation by Holmium: YSGG laser pulses in blood , 1991, Lasers in surgery and medicine.