12 May 1995 Comparison of nerve trimming with the Er:YAG laser and steel knife
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Best outcome in nerve repair requires precise alignment and minimization of scar at the repair interface. Surgeons attempt to create the sharpest cut surface at the nerve edge prior to approximation. Pulsed laser modalities are being investigated in several medical applications which require precise atraumatic cutting. We compared nerve trimming with the Er:YAG laser (1375 J/cm2) to conventional steel knife trimming prior to neurorrhaphy. Sprague- Dawley rats were anesthetized with ketamine and xylazine. Under operating microscope magnification the sciatic nerve was dissected and transected using one of the test techniques. In the laser group, the pulses were directed axially across the nerve using a stage which fixed laser fiber/nerve distance and orientation. Specimens were sent for scanning electron microscopy (SEM) at time zero. Epineurial repairs were performed with 10 - 0 nylon simple interrupted sutures. At intervals to 90 days, specimens were harvested and sectioned longitudinally and axially for histologic examination. Time zero SEM revealed clean cuts in both groups but individual axons were clearly visible in all laser specimens. Small pits were also visible on the cut surface of laser treated nerves. No significant differences in nerve morphology were seen during healing. Further studies to quantify axon counts, and functional outcome will be needed to assess this technique of nerve trimming. Delivery system improvements will also be required, to make the technique clinically practical.
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G. D. Josephson, G. D. Josephson, Lawrence S. Bass, Lawrence S. Bass, A. K. Kasabian, A. K. Kasabian, } "Comparison of nerve trimming with the Er:YAG laser and steel knife", Proc. SPIE 2395, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems V, (12 May 1995); doi: 10.1117/12.209137; https://doi.org/10.1117/12.209137

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