Thulium laser in interventional endoscopy: animal and human studies

Abstract

Background and study aims The thulium laser system (TLS) is an emerging surgical tool. The 2-μm wavelength provides a confined coagulation depth (0.2 – 0.4 mm) to reduce the potential for inadvertent injuries. For the first time ever, we assessed TLS feasibility for endoscopic hemostasis ex vivo in pigs. In addition, we performed the first in vivo hemostatic treatments in humans.

Patients and methods Tissue damage induced by TLS using different settings and optical fibers was compared to that from argon plasma coagulation (APC) in established ex vivo animal models. Three consecutive patients with complex nonvariceal upper gastrointestinal bleedings were treated and followed up.

Results No deep submucosal injury was observed in animal models. The TLS showed a progressive penetration depth with increased power outputs and tissue exposures but very limited vertical tissue injury (0.1 – 2.0 mm) and lateral spreading damage (0.1 – 0.3 mm and 0.2 – 0.7 mm using the 365-µm and 550-µm fibers, respectively). In vivo, endoscopic hemostasis with TLS was always successful without complications.

Conclusions The TLS has proven to be very precise and easy to use. This novel technique appears to be a promising tool for advanced interventional endoscopy.

• References

• 1 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: A1-A46
• 2 ASGE Technology Committee Tokar JL, Barth BA, Banerjee S. et al. Electrosurgical generators. Gastrointest Endosc; 2013 78. 197-208
• 3 Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 2005; 19: 25-31
• 4 Xia SJ, Zhuo J, Sun XW. et al. thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur Urol 2008; 53: 382-389
• 5 Zhang F, Shao Q, Herrmann TR. et al. Thulium laser versus holmium laser transurethral enucleation of the prostate: 18-month follow-up data of a single center. Urology 2012; 79: 869-874
• 6 Muto G, Collura D, Giacobbe A. et al. Thulium:yttrium-aluminum-garnet laser for en bloc resection of bladder cancer: clinical and histopathologic advantages. Urology 2014; 83: 851-855
• 7 Carmignani L, Pastore AL, Picozzi SC. et al. Thulium laser prostate enucleation in refractory urinary retention: operative and functional outcomes in a large cohort of patients. Urology 2016; 93: 152-157
• 8 Passacantilli E, Lapadula G, Caporlingua F. et al. Preparation of nasoseptal flap in trans-sphenoidal surgery using 2-μ thulium laser: technical note. Photomed Laser Surg 2015; 33: 220-223
• 9 Kirschbaum A, Höchsmann N, Steinfeldt T. et al. Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres. Lasers Med Sci 2016; 31: 1097-2103
• 10 Cho JH, Cho JY, Kim MY. et al. Endoscopic submucosal dissection using a thulium laser: preliminary results of a new method for treatment of gastric epithelial neoplasia. Endoscopy 2013; 45: 725-728
• 11 Maiss J, Wiesnet J, Proeschel A. et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37: 552-558
• 12 Wang J, Stine JG, Cornella SL. et al. Patients with gastric antral vascular ectasia (GAVE) are at a higher risk of gastrointestinal bleeding in the absence of cirrhosis. J Clin Transl Hepatol 2015; 3: 254-259
• 13 Naidu H, Huang Q, Mashimo H. Gastric antral vascular ectasia: the evolution of therapeutic modalities. Endosc Int Open 2014; 2: E67-73
• 14 Jana T, Thosani N, Fallon MB. et al. Radiofrequency ablation for treatment of refractory gastric antral vascular ectasia (with video). Endosc Int Open 2015; 3: E125-127