Endoluminal non-contact soft tissue ablation using fiber-based Er:YAG laser delivery

Abstract

The introduction of Er:YAG lasers for soft and hard tissue ablation has proven promising results over the last decades due to strong absorption at 2.94 μm wavelength by water molecules. An extension to endoluminal applications demands laser delivery without mirror arms due to dimensional constraints. Therefore, fiber-based solutions are advanced to provide exible access while keeping space requirements to a minimum. Conventional fiber-based treatments aim at laser-tissue interactions in contact mode. However, this procedure is associated with disadvantages such as advancing decrease in power delivery due to particle coverage of the fiber tip, tissue carbonization, and obstructed observation of the ablation progress. The objective of this work is to overcome aforementioned limitations with a customized fiber-based module for non-contact robot-assisted endoluminal surgery and its associated experimental evaluation. Up to the authors knowledge, this approach has not been presented in the context of laser surgery at 2.94 μm wavelength. The preliminary system design is composed of a 3D Er:YAG laser processing unit enabling automatic laser to fiber coupling, a GeO2 solid core fiber, and a customized module combining collimation and focusing unit (focal length of 20 mm, outer diameter of 8 mm). The performance is evaluated with studies on tissue substitutes (agar-agar) as well as porcine samples that are analysed by optical coherence tomography measurements. Cuts (depths up to 3mm) with minimal carbonization have been achieved under adequate moistening and sample movement (1.5mms-1). Furthermore, an early cadaver study is presented. Future work aims at module miniaturization and integration into an endoluminal robot for scanning and focus adaptation. © 2016 SPIE.