A Multi-wavelength Fiber-Optic Temperature-Controlled Laser Soldering System for Upper Aerodigestive Tract Reconstruction

Abstract

Objective. Laser soldering of a thick multilayer organ using conventional CO2 lasers is ineffective. The purpose of this work was to develop a method for bonding the multilayer tissue of the upper aerodigestive tracts (UADT) without the need of sutures or stapling. Study Design. Animal model. Setting. Academic research laboratory. Subjects and Methods. The authors developed a multi-wavelength laser system, based on 2 fiber-optic lasers applied simultaneously. A highly absorbable CO2 laser interacts with the muscular layer, and a nonabsorbable GaAs laser interacts with indocyanine-green solid albumin, placed between the mucosa and the muscular layer. The authors used an ex vivo porcine model to examine the capability of this system to effectively correct esophageal tears. Results. The soldered esophagi burst pressure was >175 cm H2O (98% success rate) in 88 of the 90 experiments. A conventional CO2 laser soldering resulted in insufficient bonding (mean burst pressure of 40 ± 7 cm H2O, n = 5), while the multi-wavelength laser system provided an ~9-fold tighter seal (359 ± 75.4 cm H2O, P < .0001, n = 15). Burst pressures after conventional suturing of the defect was significantly lower (106 ± 65.8 cm H2O, P < .001) than in the multi-wavelength laser system. Conclusions. Bonding of the UADT mucosa using a multi-wavelength, temperature-controlled laser soldering system can support significantly higher pressures then conventional CO2 laser soldering and suture repair. The mean bonding pressure was 3.5-fold higher than the maximal swallowing pressure. Our findings provide a basis for implementation of new surgical tools for repair of esophageal perforations.