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01.01.2012 | Ausgabe 1/2012

Surgical Endoscopy 1/2012

Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

Zeitschrift:
Surgical Endoscopy > Ausgabe 1/2012
Autoren:
Joyce T. Au, Arjun Mittra, Joyce Wong, Susanne Carpenter, Joshua Carson, Dana Haddad, Sebastien Monette, Paula Ezell, Snehal Patel, Yuman Fong
Wichtige Hinweise
Presented in part at the 2010 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, National Harbor, MD, 14–17 April 2010.

Abstract

Background

The CO2 laser’s unique wavelength of 10.6 μm has the advantage of being readily absorbed by water but historically limited it to line-of-sight procedures. Through recent technological advances, a flexible CO2 laser fiber has been developed and holds promise for endoluminal surgery. We examined whether this laser, along with injection of a water-based gel in the submucosal space, will allow safe dissection of the intestines and enhance the potential of this tool for minimally invasive surgery.

Methods

Using an ex vivo model with porcine intestines, spot ablation was performed with the flexible CO2 laser at different power settings until transmural perforation. Additionally, excisions of mucosal patches were performed by submucosal dissection with and without submucosal injection of a water-based gel.

Results

With spot ablation at 5 W, none of the specimens was perforated by 5 min, which was the maximum recorded time. The time to perforation was significantly shorter with increased laser power, and gel pretreatment protected the intestines against spot ablation, increasing the time to perforation from 6 to 37 s at 10 W and from 1 to 7 s at 15 W. During excision of mucosal patches, 56 and 83% of untreated intestines perforated at 5 and 10 W, respectively. Gel pretreatment prior to excision protected all intestines against perforation. These specimens were verified to be intact by inflation with air to over 100 mmHg. Furthermore, excision of the mucosal patch was complete in gel-pretreated specimens, whereas 22% of untreated specimens had residual islands of mucosa after excision.

Conclusion

The flexible CO2 laser holds promise as a precise dissection and cutting tool for endoluminal surgery of the intestines. Pretreatment with a submucosal injection of a water-based gel protects the intestines from perforation during ablation and mucosal dissection.

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