Original Investigation |

Heat Generation During Ablation of Porcine Skin With Erbium:YAG Laser vs a Novel Picosecond Infrared Laser

Nathan Jowett, MD, FRCSC1,2; Wolfgang Wöllmer, PhD2; Alex M. Mlynarek, MD, MSc, FRCSC1; Paul Wiseman, PhD3,4; Bernard Segal, PhD1; Kresimir Franjic, PhD5; Peter Krötz, MSc5; Arne Böttcher, MD2; Rainald Knecht, MD, PhD2; R. J. Dwayne Miller, PhD5
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
2Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Hamburg–Eppendorf, Hamburg, Germany
3Department of Chemistry, McGill University, Montreal, Quebec, Canada
4Department of Physics, McGill University, Montreal, Quebec, Canada
5Atomically Resolved Dynamics Division, Max Planck Research Department for Structural Dynamics, University of Hamburg, Hamburg, Germany
JAMA Otolaryngol Head Neck Surg. 2013;139(8):828-833. doi:10.1001/jamaoto.2013.3974.
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Importance  Despite significant advances in surgery, most surgical tools remain basic. Lasers provide a means of precise surgical ablation, but their clinical use has remained limited because of undesired thermal, ionizing, or acoustic stress effects leading to tissue injury. A novel ultrafast, nonionizing, picosecond infrared laser (PIRL) system has recently been developed and is capable, in theory, of ablation with negligible thermal or acoustic stress effects.

Objective  To measure and compare heat generation by means of thermography during ablation of ex vivo porcine skin by conventional microsecond-pulsed erbium:YAG (Er:YAG) laser and picosecond infrared laser (PIRL).

Design and Setting  This study was conducted in an optics laboratory and used a pretest-posttest experimental design comparing 2 methods of laser ablation of tissue with each sample acting as its own control.

Intervention  Ex vivo porcine skin was ablated in a 5-mm line pattern with both Er:YAG laser and PIRL at fluence levels marginally above ablation threshold (2 J/cm2 and 0.6 J/cm2, respectively).

Main Outcomes and Measures  Peaks and maxima of skin temperature rises were determined using a thermography camera. Means of peak temperature rises were compared using the paired sample t test. Ablation craters were assessed by means of digital microscopy.

Results  Mean peak rise in skin surface temperature for the Er:YAG laser and PIRL was 15.0°C and 1.68°C, respectively (P < .001). Maximum peak rise in skin surface temperature was 18.85°C for the Er:YAG laser and 2.05°C for the PIRL. Ablation craters were confirmed on digital microscopy.

Conclusions and Relevance  Picosecond infrared laser ablation results in negligible heat generation, considerably less than Er:YAG laser ablation, which confirms the potential of this novel technology in minimizing undesirable thermal injury associated with lasers currently in clinical use.

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Figure 1.
Experimental Thermography Setup for the Picosecond Infrared Laser System

A, Beam shaping optics; B, skin sample on translation stage; C, thermography camera; D, thermography camera output screen; E, digital microscope; F, output screen of digital microscope.

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Figure 2.
Thermal Image Frames

A, Representative thermal image frames from erbium:YAG laser ablation. B, Representative thermal image frames from picosecond infrared laser system ablation.

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Figure 3.
Thermograms for Laser Ablation

A, Thermogram for erbium:YAG laser ablation. B, Thermogram for picosecond infrared laser ablation.

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