Lasers in Surgery and Medicine最新文献

{"title":"Evaluation of thermodynamic bioeffects of long-pulsed 1064 nm laser in the photothermal lipolysis","authors":"Shan Wu MD, PhD,&nbsp;Zhixuan Jiang PhD,&nbsp;Jiying Dong MD, PhD,&nbsp;Min Yao MD, PhD","doi":"10.1002/lsm.23742","DOIUrl":"10.1002/lsm.23742","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the lipolysis effect of air cooling assisted long-pulsed 1064 laser for improving local adiposity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The second-level (pulse duration of 0.3–60 s) long-pulsed Nd:YAG 1064 nm laser (LP1064 nm) with or without forced-air cooling was used to irradiate ex-vivo subcutaneous adipose tissue (SAT) of pig or human and in-vivo inguinal fat tissue of Sprague Dawley rats. The temperature of skin surface as well as 5 mm deep SAT was monitored by a plug-in probe thermal couple, and the former was confined to 39°C or 42°C during the treatment. Histological analysis of SAT response was evaluated by SAT sections stained with hematoxylin–eosin and oil red O. Ultra-microstructure changes were examined by transmission electron microscopy. A pilot study on human subject utilizing LP1064 nm laser with air cooling was conducted. The changes in gross abdomen circumference and ultrasonic imaging were studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Histological examination showed that LP1064 nm laser treatment induced adipocyte injury and hyperthermic lipolysis both in- and ex-vivo. It was also confirmed by clinical practice on patients. By real-time temperature monitoring, we found that in comparison with LP1064 nm laser alone, additional air cooling could increase the temperature difference between epidermis and SAT, promoting heat accumulation deep in fat tissue, as well as providing better protection for epidermis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LP1064 nm laser provided reliable adipose tissue thermolysis when the temperature of skin surface was sustained at 39°C or 42°C for 10 min. Application of air-cooling during the laser treatment achieved better effect and safety of photothermal lipolysis. LP1064 nm laser, as a noninvasive device, has comparable thermal lipolysis effect as other common heat-generating devices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractional non-ablative assisted bimatoprost delivery: A synergistic approach for treating post-inflammatory hypopigmentation following cosmetic procedures in skin of color patients","authors":"Kelli Jablon BS,&nbsp;Erin Theisen MD, PhD,&nbsp;Sarah H. Hsu MD,&nbsp;Jeffrey S. Dover MD, FRCPC,&nbsp;Hye Jin Chung MD, MMSc","doi":"10.1002/lsm.23744","DOIUrl":"10.1002/lsm.23744","url":null,"abstract":"","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluence is unequal to incident energy density or radiant exposure","authors":"Martin J. C. van Gemert,&nbsp;Ton G. van Leeuwen","doi":"10.1002/lsm.23745","DOIUrl":"10.1002/lsm.23745","url":null,"abstract":"","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of quartz and sapphire optical chambers for infrared laser sealing of vascular tissues using a reciprocating, side-firing optical fiber: Simulations and experiments","authors":"Woheeb M. Saeed MS,&nbsp;Patrick J. O'Brien,&nbsp;Jude Yoshino,&nbsp;Aidan R. Restelli,&nbsp;Alexandria J. Traynham,&nbsp;Nathaniel M. Fried PhD","doi":"10.1002/lsm.23740","DOIUrl":"10.1002/lsm.23740","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Infrared (IR) lasers are being tested as an alternative to radiofrequency (RF) and ultrasonic (US) surgical devices for hemostatic sealing of vascular tissues. In previous studies, a side-firing optical fiber with elliptical IR beam output was reciprocated, producing a linear IR laser beam pattern for uniform sealing of blood vessels. Technical challenges include limited field-of-view of vessel position within the metallic device jaws, and matching fiber scan length to variable vessel sizes. A transparent jaw may improve visibility and enable custom treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quartz and sapphire square optical chambers (2.7 × 2.7 × 25 [mm³] outer dimensions) were tested, capable of fitting into a 5-mm-OD laparoscopic device. A 1470 nm laser was used for optical transmission studies. Razor blade scans and an IR beam profiler acquired fiber (550-µm-core/0.22NA) output beam profiles. Thermocouples recorded peak temperatures and cooling times on internal and external chamber surfaces. Optical fibers with angle polished distal tips delivered 94% of light at a 90° angle. Porcine renal arteries with diameters of 3.4 ± 0.7 mm (<i>n</i> = 13) for quartz and 3.2 ± 0.7 mm (<i>n</i> = 14) for sapphire chambers (<i>p</i> &gt; 0.05), were sealed using 30 W for 5 s.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Reflection losses at material/air interfaces were 3.3% and 7.4% for quartz and sapphire. Peak temperatures on the external chamber surface averaged 74 ± 8°C and 73 ± 10°C (<i>p</i> &gt; 0.05). Times to cool down to 37°C measured 13 ± 4 s and 27 ± 7 s (<i>p</i> &lt; 0.05). Vessel burst pressures (BP) averaged 883 ± 393 mmHg and 412 ± 330 mmHg (<i>p</i> &lt; 0.05). For quartz, 13/13 (100%) vessels were sealed (BP &gt; 360 mmHg), versus 9/14 (64%) for sapphire. Computer simulations for the quartz chamber yielded peak temperatures (78°C) and cooling times (16 s) similar to experiments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Quartz is an inexpensive material for use in a laparoscopic device jaw, providing more consistent vessel seals and faster cooling times than sapphire and current RF and US devices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of skin hydration on patterns of microthermal injury produced by fractional CO2 laser","authors":"Emily Wenande MD, PhD,&nbsp;Anna Hastrup BSc,&nbsp;Gabriella Louise Fredman MD,&nbsp;Uffe Høgh Olesen PhD,&nbsp;Albert Wolkerstorfer MD, PhD,&nbsp;Merete Haedersdal MD, PhD, DMSc","doi":"10.1002/lsm.23741","DOIUrl":"10.1002/lsm.23741","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The impact of skin hydration on patterns of thermal injury produced by ablative fractional lasers (AFLs) is insufficiently examined under standardized conditions. Using skin with three different hydration levels, this study assessed the effect of hydration status on microchannel dimensions generated by a fractional CO₂ laser.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A hydration model (hyperhydrated-, dehydrated- and control) was established in ex vivo porcine skin, validated by changes in surface conductance and sample mass. After, samples underwent AFL exposure using a CO₂ laser (10,600 nm) at two examined pulse energies (10 and 30 mJ/mb, fixed 10% density, six repetitions per group). Histological assessment of distinct microchannels (<i>n</i> = 60) determined three standardized endpoints in H&amp;E sections: (1) depth of microthermal treatment zones (MTZs), (2) depth of microscopic ablation zones (MAZs), and (3) coagulation zone (CZ) thickness. As a supplemental in vivo assessment, the same laser settings were applied to hyperhydrated- (7-h occlusion) and normohydrated forearm skin (no pretreatment) of a human volunteer. Blinded measurement of MAZ depth (<i>n</i> = 30) was performed using noninvasive optical coherence tomography (OCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Modest differences in microchannel dimensions were shown between hyperhydrated, dehydrated and control skin at both high and low pulse energy. Compared to controls, hyperhydration led to median reductions in MTZ and MAZ depth ranging from 5% to 8% (control vs. hyperhydrated at 30 mJ/mb; 848 vs. 797 µm (<i>p</i> &lt; 0.003) (MAZ); 928 vs. 856 µm (<i>p</i> &lt; 0.003) (MTZ)), while 14%–16% reductions were shown in dehydrated skin (control vs. dehydrated at 30 mJ/mb; MAZ: 848 vs. 727 µm (<i>p</i> &lt; 0.003); MTZ: 928 vs. 782 µm (<i>p</i> &lt; 0.003)). The impact of skin hydration on CZ thickness was in contrast limited. Corresponding with ex vivo findings, hyperhydration was similarly associated with lower ablative depth in vivo skin. Thus, median MAZ depth in hydrated skin was 10% and 14% lower than in control areas at 10 and 30 mJ/mb pulse energy, respectively (10 mJ: 210 vs. 180 µm (<i>p</i> &lt; 0.001); 30 mJ: 335 vs. 300 µm (<i>p</i> &lt; 0.001)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Skin hydration status can exert a minimal impact on patterns of microthermal injury produced by fractional CO₂ lasers, although the clinical implication in the context of laser therapy requires further study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138176571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of tissue desiccation on critical temperature for thermal damage during Er:YAG laser skin treatments","authors":"Matjaž Lukač PhD,&nbsp;Jure Košir PhD,&nbsp;Tilen Žel MSc,&nbsp;Marko Kažič BSc,&nbsp;Dominik Šavli MSc,&nbsp;Matija Jezeršek PhD","doi":"10.1002/lsm.23739","DOIUrl":"10.1002/lsm.23739","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Erbium lasers have become an accepted tool for performing both ablative and non-ablative medical procedures, especially when minimal invasiveness is desired. Hard-tissue desiccation during Er:YAG laser procedures is a well-known phenomenon in dentistry, the effect of which is to a certain degree being addressed by the accompanying cooling water spray. The desiccation of soft tissue has attracted much less attention due to the soft tissue's high-water content, resulting in a smaller effect on the ablation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>In this study, the characteristics of skin temperature decay following irradiations with Er:YAG laser pulses were measured using a fast thermal camera.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The measurements revealed a substantial increase in temperature decay times and resulting thermal exposure times following irradiations with Er:YAG pulses with fluences below the laser ablation threshold. Based on an analytical model where the skin surface cooling time is calculated from the estimated thickness of the heated superficial layer of the stratum corneum (SC), the observed phenomena is attributed to the accelerated evaporation of water from the SC's surface. By using an Arrhenius damage integral-based variable heat shock model to describe the dependence of the critical temperature on the duration of thermal exposure, it is shown that contrary to what an inexperienced practitioner might expect, the low-to-medium level fluences may result in a larger thermal damage in comparison to treatments where higher fluences are used. This effect may be alleviated by hydrating the skin before Er:YAG treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study indicates that tissue desiccation may play a more important role than expected for soft-tissue procedures. It is proposed that its effect may be alleviated by hydrating the skin before Er:YAG treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136398044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LASERS: Where we began, where we have gone, where we are now. Where will we go?","authors":"Lou Reinisch PhD","doi":"10.1002/lsm.23736","DOIUrl":"10.1002/lsm.23736","url":null,"abstract":"","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92154923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LC-OCT imaging and application to energy based device therapy","authors":"Thomas M. Beachkofsky MD,&nbsp;James M. Grichnik MD, PhD,&nbsp;Peter R. Shumaker MD","doi":"10.1002/lsm.23738","DOIUrl":"10.1002/lsm.23738","url":null,"abstract":"","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids","authors":"Vazula Zulfra Bekkers MD,&nbsp;Fatima Khan BSc,&nbsp;Pim Aarts MD,&nbsp;Katarzyna Zdunczyk MSc,&nbsp;Errol Prospero Prens MD, PhD,&nbsp;Albert Wolkerstorfer MD, PhD,&nbsp;Robert Rissmann PhD,&nbsp;Martijn Bastiaan Adriaan van Doorn MD, PhD","doi":"10.1002/lsm.23737","DOIUrl":"10.1002/lsm.23737","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients with a total of &gt;148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up ( <i>p</i> &lt; 0.001; <i>p</i> &lt; 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively ( <i>p</i> &lt; 0.001)). Adverse effects were mild. Overall, patients were “satisfied” or “very satisfied” with the treatments (14/15, 93.3%). The GAIS was “very improved” in one patient, “improved” in nine patients and “unaltered” in four patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71483043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on “Melasma treatment with a 1064 nm, picosecond-domain laser with a fractionated multibeam lens array”","authors":"Manoj Pawar MD,&nbsp;Assel Satvaldinova MD,&nbsp;Mehak Singh MD","doi":"10.1002/lsm.23735","DOIUrl":"10.1002/lsm.23735","url":null,"abstract":"","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}