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Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)

BACKGROUND AND STUDY AIMS:  The Thulium laser system (TLS) is an emerging interventional tool adopted in many surgical specialties. Its 2.0-μm wavelength allows precise coagulation (0.2 – 0.4 mm in depth) and cutting, limiting the possibilities of collateral injuries. We tested the impact of the TLS...

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Autores principales: Tontini, Gian Eugenio, Neumann, Helmut, Rimondi, Alessandro, Vavassori, Sara, Bruni, Barbara, Cattignoli, Gregorio, Zhou, Ping-Hong, Pastorelli, Luca, Vecchi, Maurizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2017
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451280/
https://www.ncbi.nlm.nih.gov/pubmed/28573173
http://dx.doi.org/10.1055/s-0043-106738
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author Tontini, Gian Eugenio
Neumann, Helmut
Rimondi, Alessandro
Vavassori, Sara
Bruni, Barbara
Cattignoli, Gregorio
Zhou, Ping-Hong
Pastorelli, Luca
Vecchi, Maurizio
author_facet Tontini, Gian Eugenio
Neumann, Helmut
Rimondi, Alessandro
Vavassori, Sara
Bruni, Barbara
Cattignoli, Gregorio
Zhou, Ping-Hong
Pastorelli, Luca
Vecchi, Maurizio
author_sort Tontini, Gian Eugenio
collection PubMed
description BACKGROUND AND STUDY AIMS:  The Thulium laser system (TLS) is an emerging interventional tool adopted in many surgical specialties. Its 2.0-μm wavelength allows precise coagulation (0.2 – 0.4 mm in depth) and cutting, limiting the possibilities of collateral injuries. We tested the impact of the TLS for gastric endoscopic submucosal dissection (ESD) and per oral endoscopic myotomy (POEM) ex vivo in pigs. MATERIALS AND METHODS:   Ex vivo porcine stomach and esophagus models underwent 2 POEMs, and 3 ESDs (mean diameter 3.5 cm) with TLS using a 272-µm and a 365-µm thick optical fibers. Both continuous and pulsed laser emission were evaluated. Subsequent histopathological analysis was performed by an expert GI pathologist on the whole porcine models. RESULTS:  Complete POEMs and gastric ESDs were successfully performed in all cases in 30 to 70 and 15 to 20 minutes. Both optical fibers were equally effective and precise. The best power output for mucosal incision was 25 to 30 W during ESD and 25 W for POEM using continuous laser emission. During submucosal dissection and tunneling the favorite power output was 20 W and 15 to 20 W, respectively, operating in continuous mode. No transmural perforation occurred throughout the operations and histopathology confirmed the absence of accidental muscular layer damage. CONCLUSIONS:  The TLS stands out as a precise and manageable instrument in ex vivo models. This technique appears to be a promising tool for advanced interventional endoscopy.
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spelling pubmed-54512802017-06-01 Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos) Tontini, Gian Eugenio Neumann, Helmut Rimondi, Alessandro Vavassori, Sara Bruni, Barbara Cattignoli, Gregorio Zhou, Ping-Hong Pastorelli, Luca Vecchi, Maurizio Endosc Int Open BACKGROUND AND STUDY AIMS:  The Thulium laser system (TLS) is an emerging interventional tool adopted in many surgical specialties. Its 2.0-μm wavelength allows precise coagulation (0.2 – 0.4 mm in depth) and cutting, limiting the possibilities of collateral injuries. We tested the impact of the TLS for gastric endoscopic submucosal dissection (ESD) and per oral endoscopic myotomy (POEM) ex vivo in pigs. MATERIALS AND METHODS:   Ex vivo porcine stomach and esophagus models underwent 2 POEMs, and 3 ESDs (mean diameter 3.5 cm) with TLS using a 272-µm and a 365-µm thick optical fibers. Both continuous and pulsed laser emission were evaluated. Subsequent histopathological analysis was performed by an expert GI pathologist on the whole porcine models. RESULTS:  Complete POEMs and gastric ESDs were successfully performed in all cases in 30 to 70 and 15 to 20 minutes. Both optical fibers were equally effective and precise. The best power output for mucosal incision was 25 to 30 W during ESD and 25 W for POEM using continuous laser emission. During submucosal dissection and tunneling the favorite power output was 20 W and 15 to 20 W, respectively, operating in continuous mode. No transmural perforation occurred throughout the operations and histopathology confirmed the absence of accidental muscular layer damage. CONCLUSIONS:  The TLS stands out as a precise and manageable instrument in ex vivo models. This technique appears to be a promising tool for advanced interventional endoscopy. © Georg Thieme Verlag KG 2017-06 2017-05-31 /pmc/articles/PMC5451280/ /pubmed/28573173 http://dx.doi.org/10.1055/s-0043-106738 Text en © Thieme Medical Publishers
spellingShingle Tontini, Gian Eugenio
Neumann, Helmut
Rimondi, Alessandro
Vavassori, Sara
Bruni, Barbara
Cattignoli, Gregorio
Zhou, Ping-Hong
Pastorelli, Luca
Vecchi, Maurizio
Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title_full Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title_fullStr Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title_full_unstemmed Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title_short Ex vivo experimental study on the Thulium laser system: new horizons for interventional endoscopy (with videos)
title_sort ex vivo experimental study on the thulium laser system: new horizons for interventional endoscopy (with videos)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451280/
https://www.ncbi.nlm.nih.gov/pubmed/28573173
http://dx.doi.org/10.1055/s-0043-106738
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