Laser energy sealing systems have attracted much attention over the past decade given the general shift in surgical paradigm toward less invasive surgical approaches. Given this, it is paramount to have an objective method with which the quality of energy seals can be evaluated. Current methodologies used for this purpose can be problematic in the evaluation of small vessel seals. A methodology employing Doppler optical coherence tomography (DOCT) for the evaluation of energy seals is introduced. Avian chorioallantoic membrane vessels were subjected to thulium laser irradiation and were then scanned via OCT. Outcomes were classified based on several markers, predominantly the presence or absence of flow postirradiation. Vessel diameter and general morphology were also taken into consideration. Vessels were classified into four groups: seal (29%), rupture (30%), partial seal (19%), and unaffected (22%). All vessels were also evaluated visually by a trained neurovascular surgeon, and these visually classified outcomes were compared with DOCT evaluated outcomes. It was found that whether the vessel was considered sealed or not sealed was dependent on the evaluation method (p = 0.01) where visual classification resulted in 18% more seals than DOCT classification. Further, the specificity of visual classification was found to be strongly dependent on the number of partial seals (p < 0.0001). DOCT has shown to be an indispensable method for the evaluation of energy seals not only solely due to its high velocity resolution but also due to valuable microscopic morphological insight regarding the biological mechanisms responsible for energy sealing.
Tissue removal using electrocautery is standard practice in neurosurgery since tissue can be cut and cauterized simultaneously. Thermally mediated tissue ablation using lasers can potentially possess the same benefits but with increased precision. However, given the critical nature of the spine, brain, and nerves, the effects of direct photo-thermal interaction on neural tissue needs to be known, yielding not only high precision of tissue removal but also increased control of peripheral heat damage. The proposed use of lasers as a neurosurgical tool requires that a common ground is found between ablation rates and resulting peripheral heat damage.
Most surgical laser systems rely on the conversion of light energy into heat resulting in both desirable and undesirable thermal damage to the targeted tissue. Classifying the distribution of thermal energy in neural tissue, and thus characterizing the extent of undesirable thermal damage, can prove to be exceptionally challenging considering its highly inhomogenous composition when compared to other tissues such as muscle and bone. Here we present the characterization of neural tissue ablation rate and heat affected zone of a 1.94 micron thulium doped fiber laser for neural tissue ablation. In-Vivo ablation of porcine cerebral cortex is performed. Ablation volumes are studied in association with laser parameters. Histological samples are taken and examined to characterize the extent of peripheral heat damage.