Combined Nd:YAG and Er:YAG lasers for real-time closed-loop tissue-specific laser osteotomy

A novel real-time and non-destructive method for differentiating soft from hard tissue in laser osteotomy has been introduced and tested in a closed-loop fashion. Two laser beams were combined: a low energy frequency-doubled nanosecond Nd:YAG for detecting the type of tissue, and a high energy microsecond Er:YAG for ablating bone. The working principle is based on adjusting the energy of the Nd:YAG laser until it is low enough to create a microplasma in the hard tissue only (different energies are required to create plasma in different tissue types). Analyzing the light emitted from the generated microplasma enables real-time feedback to a shutter that prevents the Er:YAG laser from ablating the soft tissue. © 2020 Optical Society of America under the terms of the OSA Open Access Publishing Agreement

[1]  Y. Suzaki,et al.  Measurement of the microm sized radius of Gaussian laser beam using the scanning knife-edge. , 1975, Applied optics.

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

[3]  Werner Lauterborn,et al.  Optical and acoustic investigations of the dynamics of laser-produced cavitation bubbles near a solid boundary , 1989, Journal of Fluid Mechanics.

[4]  S. Jacques,et al.  THE MELANOSOME: THRESHOLD TEMPERATURE FOR EXPLOSIVE VAPORIZATION AND INTERNAL ABSORPTION COEFFICIENT DURING PULSED LASER IRRADIATION , 1991, Photochemistry and photobiology.

[5]  Steven L. Jacques,et al.  How tissue optics affect dosimetry for photochemical, photothermal, and photomechanical mechanisms of laser-tissue interaction. , 1992 .

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

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

[8]  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.

[9]  Steven L. Jacques,et al.  Working theory and experiments on photomechanical disruption of melanosomes to explain the threshold for minimal visible retinal lesions for sub-ns laser pulses , 1994, SPIE LASE.

[10]  J. Walsh,et al.  Erbium laser ablation of dental hard tissue: Effect of water cooling , 1996, Lasers in surgery and medicine.

[11]  Steven L. Jacques,et al.  Internal absorption coefficient and threshold for pulsed laser disruption of melanosomes isolated from retinal pigment epithelium , 1996, Photonics West.

[12]  Frank K. Tittel,et al.  Effect of tensile stress amplitude and temporal characteristics on threshold of cavitation-driven ablation , 1996, Photonics West.

[13]  A. Vogel,et al.  Nonlinear absorption: intraocular microsurgery and laser lithotripsy. , 1997, Physics in medicine and biology.

[14]  A. Vogel,et al.  Influence of pulse duration on mechanical effects after laser-induced breakdown in water , 1998 .

[15]  Daniel Fried,et al.  Laser ablation of skull tissue using transverse excited 9.6-μm CO2 lasers with pulse durations of 1-100 μs , 2000, Photonics West - Biomedical Optics.

[16]  N. Fried,et al.  Comparison of Er:YAG and 9.6‐μm TE CO2 lasers for ablation of skull tissue , 2001 .

[17]  Peter Kessler,et al.  Er:YAG laser osteotomy directed by sensor controlled systems. , 2003, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[18]  A. Vogel,et al.  Mechanisms of Pulsed Laser Ablation of Biological Tissues , 2003 .

[19]  A. Vogel,et al.  Mechanisms of pulsed laser ablation of biological tissues. , 2003, Chemical reviews.

[20]  Katja Tangermann-Gerk,et al.  Sensor-based laser ablation for tissue specific cutting: an experimental study , 2004, Lasers in Medical Science.

[21]  T. A. King,et al.  Erbium-YAG and holmium-YAG laser ablation of bone , 1990, Lasers in Medical Science.

[22]  J. Boulnois,et al.  Photophysical processes in recent medical laser developments: A review , 2005, Lasers in Medical Science.

[23]  Peter Hering,et al.  Ablation of hard bone tissue with pulsed CO2 lasers , 2005 .

[24]  Bruno Girard,et al.  Bone surgery with femtosecond laser compared to mechanical instruments: healing studies , 2006, SPIE High-Power Laser Ablation.

[25]  William A Farinelli,et al.  Vertical ramus osteotomy with Er:YAG laser: a feasibility study. , 2007, International journal of oral and maxillofacial surgery.

[26]  Luke A. Reisner,et al.  A prototype biosensor‐integrated image‐guided surgery system , 2007, The international journal of medical robotics + computer assisted surgery : MRCAS.

[27]  Y. Huang,et al.  Average-power mediated ultrafast laser osteotomy using a mode-locked Nd:YVO4 laser oscillator. , 2007, Journal of biomedical optics.

[28]  Emeka Nkenke,et al.  Optical Nerve Detection by Diffuse Reflectance Spectroscopy for Feedback Controlled Oral and Maxillofacial Laser Surgery , 2011, Journal of Translational Medicine.

[29]  E. Nkenke,et al.  In vivo soft tissue differentiation by diffuse reflectance spectroscopy: preliminary results , 2010 .

[30]  Emeka Nkenke,et al.  Diffuse reflectance spectroscopy for optical soft tissue differentiation as remote feedback control for tissue‐specific laser surgery , 2010, Lasers in surgery and medicine.

[31]  Stefan Stübinger,et al.  Advances in bone surgery: the Er:YAG laser in oral surgery and implant dentistry , 2010, Clinical, cosmetic and investigational dentistry.

[32]  A. Vogel,et al.  Pulsed Laser Ablation of Soft Biological Tissues , 2010 .

[33]  Fekrazad Reza,et al.  Laser in Orthodontics , 2011 .

[34]  Zhenpeng Qin,et al.  Thermophysical and biological responses of gold nanoparticle laser heating. , 2012, Chemical Society reviews.

[35]  Hubert Roth,et al.  A spectroscopic approach to monitor the cut processing in pulsed laser osteotomy , 2012, Lasers in Medical Science.

[36]  Kishan Dholakia,et al.  Raman Spectroscopy Sensor for Surgical Robotics – Instrumentation and Tissue Differentiation Algorithm , 2012 .

[37]  A. Gholami,et al.  Thermal Effects of Laser-osteotomy on Bone: Mathematical Computation Using Maple , 2013, Journal of medical signals and sensors.

[38]  Fanuel Mehari,et al.  Pilot study of laser induced breakdown spectroscopy for tissue differentiation by monitoring the plume created during laser surgery — An approach on a feedback Laser control mechanism , 2013 .

[39]  Janez Diaci,et al.  Measurements of erbium laser-ablation efficiency in hard dental tissues under different water cooling conditions , 2013, Journal of biomedical optics.

[40]  S. Jacques.  Optical properties of biological tissues: a review , 2013, Physics in medicine and biology.

[41]  Emeka Nkenke,et al.  Tissue Discrimination by Uncorrected Autofluorescence Spectra: A Proof-of-Principle Study for Tissue-Specific Laser Surgery , 2013, Sensors.

[42]  Arne Böttcher,et al.  Bone Ablation without Thermal or Acoustic Mechanical Injury via a Novel Picosecond Infrared Laser (PIRL) , 2014, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[43]  Kishan Dholakia,et al.  A Raman spectroscopy bio‐sensor for tissue discrimination in surgical robotics , 2014, Journal of biophotonics.

[44]  S. Musić,et al.  Morphological and ultrastructural comparative analysis of bone tissue after Er:YAG laser and surgical drill osteotomy. , 2014, Photomedicine and laser surgery.

[45]  Fanuel Mehari,et al.  Laser induced breakdown spectroscopy for bone and cartilage differentiation - ex vivo study as a prospect for a laser surgery feedback mechanism. , 2014, Biomedical optics express.

[46]  Jian Liu,et al.  Smart surgical tool , 2015, Journal of biomedical optics.

[47]  Valery V. Tuchin,et al.  Tissue Optics and Photonics: Light-Tissue Interaction , 2015 .

[48]  Michael Schmidt,et al.  Qualitative tissue differentiation by analysing the intensity ratios of atomic emission lines using laser induced breakdown spectroscopy (LIBS): prospects for a feedback mechanism for surgical laser systems , 2013, Journal of biophotonics.

[49]  Sungho Jeong,et al.  Differentiation of cutaneous melanoma from surrounding skin using laser-induced breakdown spectroscopy , 2016, 2016 Conference on Lasers and Electro-Optics (CLEO).

[50]  Brian W Pogue,et al.  Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging , 2016, Journal of biomedical optics.

[51]  Fanuel Mehari,et al.  Investigation of the differentiation of ex vivo nerve and fat tissues using laser‐induced breakdown spectroscopy (LIBS): Prospects for tissue‐specific laser surgery , 2016, Journal of biophotonics.

[52]  A. Vogel,et al.  Wavelength dependence of femtosecond laser-induced breakdown in water and implications for laser surgery , 2016 .

[53]  Majid Nazeri,et al.  Laser-Induced Breakdown Spectroscopy Via the Spatially Resolved Technique Using Non-Gated Detector , 2016 .

[54]  David G. Kirsch,et al.  A Fluorescence-Guided Laser Ablation System for Removal of Residual Cancer in a Mouse Model of Soft Tissue Sarcoma , 2016, Theranostics.

[55]  Jung Hyun Han,et al.  Elemental analysis of tissue pellets for the differentiation of epidermal lesion and normal skin by laser-induced breakdown spectroscopy , 2016, Biomedical optics express.

[56]  Yoshinori Harada,et al.  Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery , 2017, BiOS.

[57]  Fanuel Mehari,et al.  The differentiation of oral soft‐ and hard tissues using laser induced breakdown spectroscopy – a prospect for tissue specific laser surgery , 2017, Journal of biophotonics.

[58]  Philippe C. Cattin,et al.  Effect of cooling water on ablation in Er:YAG laserosteotome of hard bone , 2017, Applications of Optics and Photonics.

[59]  G. Rauter,et al.  Effect of laser pulse duration on ablation efficiency of hard bone in microseconds regime , 2017, Applications of Optics and Photonics.

[60]  Hans-Florian Zeilhofer,et al.  Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®) - A study on applicability and effectiveness in human cadavers. , 2018, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[61]  Hamed Abbasi,et al.  Laser-induced breakdown spectroscopy as a potential tool for autocarbonization detection in laserosteotomy , 2018, Journal of biomedical optics.

[62]  Kenneth H. Chan,et al.  Selective ablation of carious lesions using an integrated multispectral near-IR imaging system and a novel 9.3-μm CO2 laser , 2018 .

[63]  Xin Yu,et al.  Discrimination of lymphoma using laser-induced breakdown spectroscopy conducted on whole blood samples. , 2018, Biomedical optics express.

[64]  Hervé Nguendon Kenhagho,et al.  Optoacoustic Tissue Differentiation Using a Mach-Zehnder Interferometer: Preliminary Results , 2018, 2018 IEEE International Ultrasonics Symposium (IUS).

[65]  Philippe C. Cattin,et al.  Performance of Er:YAG laser ablation of hard bone under different irrigation water cooling conditions , 2018, BiOS.

[66]  Philippe C. Cattin,et al.  Optimizing controlled laser cutting of hard tissue (bone) , 2018, Autom..

[67]  Xin Yu,et al.  Discrimination of soft tissues using laser-induced breakdown spectroscopy in combination with k nearest neighbors (kNN) and support vector machine (SVM) classifiers , 2018, Optics & Laser Technology.

[68]  P. Cattin,et al.  Pilot Ex Vivo Study of Laser-Induced Breakdown Spectroscopy to Detect Bone Dehydration: An Approach for Irrigation Feedback in Laserosteotomy , 2018 .

[69]  M. Licata,et al.  Conservative Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw with Er,Cr:YSGG Laser and Platelet-Rich Plasma: A Longitudinal Study , 2018, BioMed research international.

[70]  Fanuel Mehari,et al.  LIBS based Tissue Differentiation for Er: YAG Surgical Laser , 2018, PHOTOPTICS.

[71]  Philippe C. Cattin,et al.  Plasma plume expansion dynamics in nanosecond Nd:YAG laserosteotome , 2018, BiOS.

[72]  Philippe C. Cattin,et al.  Differentiation of femur bone from surrounding soft tissue using laser-induced breakdown spectroscopy as a feedback system for smart laserosteotomy , 2018, Photonics Europe.

[73]  Philippe C. Cattin,et al.  Neural network in tissue characterization of Optical Coherence Tomography (OCT) image for smart laser surgery: preliminary study , 2019, International Seminar on Photonics, Optics, and its Applications.

[74]  P. Friedl,et al.  Compatibility of CO2 laser surgery and fluorescence detection in head and neck cancer cells , 2018, Head & neck.

[75]  C. Chen,et al.  Investigation of random lasing as a feedback mechanism for tissue differentiation during laser surgery. , 2019, Biomedical Optics Express.

[76]  Z. Zalevsky,et al.  Contact‐free endoscopic photoacoustic sensing using speckle analysis , 2019, Journal of biophotonics.

[77]  Philippe C. Cattin,et al.  Fast optical coherence tomography image enhancement using deep learning for smart laser surgery: preliminary study in bone tissue , 2019, Fourth International Conference on Applications of Optics and Photonics.

[78]  P. Cattin,et al.  Design and implementation of a compact high-throughput echelle spectrometer using off-the-shelf off-axis parabolic mirrors for analysis of biological samples by LIBS (Conference Presentation) , 2019, Optical Methods for Inspection, Characterization, and Imaging of Biomaterials IV.

[79]  Zeev Zalevsky,et al.  Acoustic differentiation of dental soft and hard tissues using remote speckle-analysis during Er:YAG ablation , 2019, European Conference on Biomedical Optics.

[80]  A. Aoki,et al.  Evaluation of bone healing following Er:YAG laser ablation in rat calvaria compared with bur drilling , 2018, Journal of biophotonics.

[81]  Brett Robertson,et al.  Machine learning classification of human joint tissue from diffuse reflectance spectroscopy data. , 2019, Biomedical optics express.

[82]  S. H. Tavassoli,et al.  Feasibility Study on Discrimination of Neo-plastic and Non-Neoplastic Gastric Tissues Using Spark Discharge Assisted Laser Induced Breakdown Spectroscopy. , 2018, Journal of lasers in medical sciences.

[83]  Saeidi,et al.  Characterization of Ablated Bone and Muscle for Long-Pulsed Laser Ablation in Dry and Wet Conditions , 2019, Materials.

[84]  P. Cattin,et al.  Optoacoustic Tissue Differentiation Using a Mach–Zehnder Interferometer , 2019, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[85]  Fanuel Mehari,et al.  Remote photoacoustic sensing using speckle-analysis , 2019, Scientific Reports.

[86]  Tracked Changes. Lasers and laser-related equipment. Test methods for laser beam widths, divergence angles and beam propagation ratios , 2022 .