Successful laser-assisted tissue welding was implemented to provide proper weld strength with minimized tissue thermal injury. We investigated and compared the weld strengths and morphologic changes in porcine small intestinal submucose (SIS) and porcine ureteral tissues with various concentration of indocyanine green (ICG) and with a solid albumin sheet. The study showed that the tissues were welded at lower ICG concentration (0.05 mM) with minimized tissue thermal damage using an 800-nm wavelength diode laser.
Porcine ureters were anastomosed using an albumin stent and diode laser in vitro. The albumin stent provided precise apposition for an end to end anastomosis and enhanced welding strength. The anastomosis seam was lasered with an 810 nm diode laser using continuous wave and pulse light through a hand-held 600 micrometer noncontact optical fiber. Tensile strength, burst pressures, operative times, total energy and thermal damaged were measured in this study. The results demonstrated that using an albumin stent to laser weld ureteral anastomoses produces strong weld strengths. The liquid albumin solder also provided satisfactory welding strength. There were no significant differences of tissue thermal damage between the albumin stent alone, liquid solder alone and both combination groups. Thermal damage to tissue depended on laser setting and energy. This study determined the appropriate laser setting parameters to perform in vivo ureteral end to end anastomosis.
Sutureless end to end ureteral anastomoses was successfully constructed in acute and chronic experiments. A photothermal sensitive hydrolyzable (PSH) albumin stent played roles as solder and intraluminal supporter to adhesion and position the anastomosed ureter by end to end fashion. The anastomosis seam was lased with 810 nm diode laser energy supplied through hand- held 600 micrometers noncontact optical fiber. A continuous 1 watt wave of power was applied for laser anastomosis. Integrity, welding strength, bursting pressures of anastomosis and histological reaction, and radiological phenomena were compared to those of anastomoses constructed using a liquidity soldering technique. The acute results of two methods were equivalent at welding strengths, but the liquid soldering showed more energy consumption. At chronic study, the radiological and histological studies were performed to evaluate the complications of the anastomosis. Excellent heating and varied degrees of complications were observed. We conclude that PSH stent showed great promise for ureteral anastomosis using laser welding.
Preliminary results of a randomized study comparing laser ablation of the prostate (LAP) to transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic hyperplasia are reviewed. Forty-five men enrolled in the study had a minimum 6 week followup. Preoperative AUA symptom scores, peak urinary flow rates, and post-void residual urines (PVR) were compared to postoperative values. The TURP group (22 men) did better than its LAP cohort (23 men) with a mean decrease in symptom score of 70% versus 47%, a mean increase in flow rate of 83% versus 53%, and a mean decrease in PVR of 51% versus 28%, respectively, at 12 weeks. LAP patients had less complications associated with impotence and retrograde ejaculation, required urethral catheters for less time, and had shorter hospital stays. With the development of more durable and reflective fibers the difference in efficacy between TURP and LAP should diminish while the benefits of LAP are preserved.
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