In this study, a NIR erbium fiber laser tuned to a water vibrational overtone absorption band at 1455 nm was used to weld directly, in vitro, seventy-six porcine aorta tissues without the need for extrinsic solder materials. The tissues were divided into eleven groups based on the multiple and variable parameters that were used to weld the tissues. The effectiveness of the parameters used in each of the weld groups was evaluated directly at the time of the weld and also by tensile strength measurements done at the termination of the weld. Management of heat produced in tissues is of critical importance for good laser tissue welding (LTW). To address heat
management issues, we report LTW using a transparent cover over the tissue specimen as a heat sink. Multiple scanning helps distribute the laser-generated heat and allows the tissue to cool between scans, reducing thermal damage. Better heat management using a transparent cover slide enhances the welding success. It reduces collateral damage and limits water evaporation and control the buckling of tissue around the line of apposition so that the two pieces that are welded do not move apart along the line of apposition due to buckling pressure and ensure a full-length weld.
In this study, 72 different combinations of laser welding parameters were compared for their effectiveness in welding ocular tissue. The laser employed in the welding system was a near infrared (NIR) erbium fiber laser with a wavelength of 1.455 μm . The laser system used a motorized translational stage and shutter to control the laser exposure of the tissue being welded. The emission wavelength of the laser in the NIR range corresponds to one of the lesser absorption bands of water. Parameters of the laser welding system that could be changed to allow a more effective distribution of the laser energy and therefore management of thermal energy included: the number and kinds of intricate offset patterns of light on or around the incision, the number of lines per pattern, the power level, the speed of the laser beam movement over the tissues, the spot size, dwell time and the focus plane of the light beam in the tissue. Histopathology was used as an endpoint indication of the effects that the various sets of welding parameters had on the welded tissues. Standard Hematoxylin and Eosin stain and Sirius Red F3B (Direct Red 80) in combination with polarization microscopy were used to stain and visualize the welded ocular tissue. Paradoxically, the best cornea welds quantified using histopathology occurred with fluence of 4,500 mJ/cm<sup>2</sup> or less while the corneal welds exhibiting the strongest tensile strengths, but most tissue damage had a delivered fluence above 7,000 mJ/cm<sup>2</sup>. The best histological representatives of welded corneas had an average delivered fluence of 2,687 mJ/cm<sup>2</sup> and an irradiance of 14 W/cm<sup>2</sup>. Using the properly determined parameters, the NIR erbium fiber welding system provided full thickness welds without the requirement of extrinsic dyes, chromophores, or solders. The NIR laser system with the appropriately developed parameters can be used effectively to weld ocular tissues.
Monte Carlo simulations were performed to delineate the role of local fluence rates and absorption in histologic success and tensile strength analysis of laser welding of ocular corneal tissue using an erbium fiber laser system operating at 1455nm wavelength. Porcine cornea was used for in vitro welding, while varying power, scan time, and irradiance. Immediate histologic analysis was performed, as well as tensile strength studies. Simulations were performed using MCML code, with a total of 10<sup>9</sup> photons started. CONV code was used to convolve the output from MCML for a flat photon beam of 80-800 μ focal spot size and power specified by the experiment. The absorption coefficient, μa, was assumed to reflect that of water, 28.6 cm<sup>-1</sup>. The scattering coefficient, μs, and anisotropy factor, g, were both neglected due to the poor scattering capabilities of water in the wavelength of the laser beam. Fluence rates were determined and were within 0.3%-4% of surface dose calculations for a beam diameter of 80 μ. Interactive Data Language (IDL) was used to sum the dose for one convolved beam to an experiment with multiple scans across the porcine cornea. Achieving optimal usage of the laser system requires maximal use of the variables (power, scan patterns, scan time, irradiance) available to use, and the correlation between Monte Carlo-aided dosimetry and the histopathological and tensile strength studies was performed. Optimal parameters for use in this 1455 nm laser system can be studied, and will allow users the ability to predict histology scores of welding success and tissue injury based on absorption values. These results can refine our experience with laser tissue welding of porcine cornea and aid in determining optimal delivered dose for successful tissue apposition and minimal adverse thermal heating.
Laser skin welding (LSW) is being pursued for scarless wound healing. We present a new LSW approach using a contact glass slide over the sample and rapid scanning of the laser beam around the area to be welded. This led to dramatic improvement in welding efficacy. A 400 mW beam at 1455 nm with a focused spot diameter of 80 μm in air was scanned at a rate of 5mm/second over a 5mm line of incision in 5 mm x 20 mm human skin samples. Histological analysis of the welded samples using hematoxyline and eosin under unpolarized light showed full-thickness full-length weld, and that with picrosirius red F3BA stain under polarized light revealed that there was no appreciable damage. Measured tensile strength of 2.1 kg/cm<sup>2</sup> is markedly greater than our previous LSW results of 1.05 ± 0.19 kg/cm<sup>2</sup>, which is greater than the typical values of 0.4 kg/cm<sup>2</sup> obtained using sutures.
In this study, an NIR fiber laser with an eye safe wavelength of 1.455 μm was used to successfully weld <i>in vitro</i> porcine cornea and sclera tissue. The emission wavelength overlaps an absorption band of water. The laser system was used in combination with a motorized translational system and shutter to control the laser exposure on the tissue being welded. Different welding conditions were analyzed for the porcine cornea and sclera. The welded tissues were examined using histopathology and tensile strength analysis. The NIR welding technique provides strong, full thickness welds and does not require the use of extrinsic dyes, chromophores, or solders. The NIR laser system used in this study can effectively weld cornea and sclera tissue, and this laser tissue welding (LTW) methodology typically causes minimal disruption of tissue, and thus, avoids opacities and irregularities in the tissue which may result in decreased visual acuity.
<i>Ex vivo</i> specimens of human and porcine aorta and skin were welded using either Cr<sup>4+</sup>:YAG or Erbium fiber lasers tuned to the water absorption band at 1440-1460 nm. Welding was performed without the use of protein solders or glues. Welding efficacy was monitored by measuring the tensile strength of the welded tissue and the extent of collateral tissue damage. Full thickness tissue bonding with no collateral damage was observed with porcine aorta samples. The optimum tensile strength for porcine and human aorta was 1.33 ± 0.15 kg/cm<sup>2</sup> and 1.13 ± 0.27 kg/cm<sup>2</sup> respectively for welding at 1460 nm, while that for porcine and human skin was 0.94 ± 0.15 kg/cm<sup>2</sup> and 1.05 ± 0.19 kg/cm<sup>2</sup> respectively achieved with welding at 1455 nm. The weld strength as a function of laser wavelength demonstrated a correlation with the absorption spectrum of native water suggests that absorption of light by water in the tissue plays a significant role in laser tissue welding.
Laser tissue welding involves the partial denaturing and renaturing of the collagen triple helical structure. Although the mechanisms of laser tissue welding are not well understood, water in tissues plays an important role in the process. High quality welding of human and porcine aorta tissue have been achieved using NIR lasers tuned to the water absorption band around 1450 nm. Fluorescence and Raman spectra from welded and non-welded regions are compared for <i>ex vivo</i> human and porcine aorta tissues. The fluorescence from the outer surface of welded aorta was substantially weaker than the fluorescence from the non-welded region. The Raman spectra from the welded and non-welded tissue regions appeared similar in the energies of the observed vibrational levels but the intensity of the fluorescence wing was considerably greater from the outer surface of the welded region as compared to the non-welded region. For the outer surface of the aorta, the emission intensity from the welded region was larger than for the non-welded region.