Is the Erbium-YAG laser an effective alternative to the CO2 laser in Head and Neck surgery?

Introduction:

The CO2 laser has been established as a surgical standard procedure especially in the oropharynx and larynx. However, it causes a comparatively large coagulation zone. The erbium:YAG (Er:YAG) laser achieves less coagulation damage through high tissue absorption. But due to its low repetition rate, the flashlamp pumped Er:YAG laser has only been used to ablate superficial structures. We, therefore, compared the diode pumped Er:YAG laser of the Institute of Lasertechnology Ulm with the standard CO2 laser.

Methods:

With the CO2 laser (continuous pulse, Lumenis®) and the diode pumped Erb:YAG laser of the ILM Ulm (300A, 200 Hz, 154µs), 3 sections (1.5 cm) were performed on the mucosa of porcine tongues, respectively. The lasers were used with 7.7W at a speed of 2, 5 and 10 mm/s. Azan-stained histological specimens (n = 18) were examined microscopically for depth of cut and width of the coagulation zone.

Results:

The Er:YAG laser cuts twice as deep as the CO2 laser at a rate of 2 mm/s (2240 vs. 1298 µm), 5 mm/s (1124 vs. 551 µm) and 10 mm/s (710 vs. 380 µm). The Er:YAG laser causes a significantly lower coagulation width than the CO2 laser at a speed of 2 mm/s (96 vs. 234 µm), 5 mm/s (67 vs. 123 µm) and 10 mm/s (31 vs. 91 µm).

Conclusion:

In the ex vivo animal experiments, the Er: YAG laser shows better cutting properties than the CO2 laser. In vivo experiments to assess improved hemostasis and reduced scarring are being prepared.

Publication History

Publication Date:
23 April 2019 (online)