PubMed · 10172198
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1995. OR technology: microrobots, computer aids, tissue welding.. https://pubmed.ncbi.nlm.nih.gov/10172198/
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BACKGROUND AND OBJECTIVE: Motivated by the potential for highly precise tissue removal, investigators are exploring fiberoptic microsurgical maneuvers with the erbium:YAG (Er:YAG) laser. Tissue is disrupted and removed by direct ablation and the acousto-mechanical sequelae of explosive vaporization of the tissue water. The authors investigated the scaling laws for photoablative and photodisruptive interactions and interpreted these results to optimize energy delivery for vitreoretinal surgical maneuvers. MATERIALS AND METHODS: A model for laser-generated-bubble expansion is presented based on energy principles and adiabatic gas expansion. Comparisons are made with the authors' previous studies of ablation rate and thermometry. RESULTS: The authors' modeling studies generated predictions similar to experimental data. The maximum bubble diameter increases as the cube root of the pulse energy. At constant radiant exposure, the maximum bubble diameter increases as the probe tip diameter raised to the two-thirds power. The authors demonstrated that tissue ablation depends on radiant exposure (J/cm2), whereas temperature increases, bubble size, and peak pressure depend on total pulse energy. CONCLUSIONS: Mechanical injury should be minimized and efficient ablation preserved by delivering low-pulse energy through small-diameter probe tips at high repetition rates.
When a cryogen spurt is applied to the skin surface for an appropriately short period of time (on the order of tens of milliseconds), the spatial distribution of cooling remains localized in the normal overlying epidermis, while leaving the temperature of the deeper port wine stain (PWS) blood vessels unchanged. Furthermore, cooling continues after pulsed laser exposure as cryogen remaining on the surface evaporates and removes heat deposited by light absorption in epidermal melanin. An additional advantage of dynamic cooling is a reduction in the level of pain and discomfort associated with flashlamp-pumped pulsed dye laser therapy of PWS. Preliminary clinical studies and supporting theoretical calculations demonstrate the feasibility of selective epidermal cooling while achieving photothermolysis of blood vessels during pulsed laser treatment of PWS.