Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

If a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.

Nhân một trường hợp điều trị hẹp khí quản thứ phát sau thở máy bằng tia laser Thulium

Trẻ nam, 10 tuổi vào viện trong tình trạng khó thở. Tiền sử thở máy kéo dài, mở khí quản do chấn thương. Trẻ bị hẹp khí quản nặng do sẹo đã nong hẹp 4 lần bằng bóng và ống cứng tại Bệnh viện Nhi đồng 2 nhưng không thành công. Chúng tôi đã tiến hành nội soi ống mềm phát hiện khí quản dưới thanh môn 2 cm hẹp trên 75% khẩu kính, đoạn hẹp dài 1cm. Trẻ được điều trị bằng phương pháp đốt laser fibre Thilium qua nội soi khí quản ống mềm. Sau 3 tháng kiểm tra lại, khẩu kính đoạn hẹp mở rộng gần như bình thường, còn chân sẹo hẹp nhỏ, không ảnh hưởng đến thông khí. Laser fiber Thilium điều trị sẹo hẹp thứ phát mang lại hiệu quả tốt, an toàn, rút ngắn thời gian điều trị.

Curved adjustable fibre-optic diode laser in microscopic cholesteatoma surgery: description of use and review of the relevant literature

Objective:The use of lasers in cholesteatoma surgery is common and well accepted. The most commonly used laser fibres are straight and non-adjustable; these have several limitations. This paper describes the use of an alternative laser fibre.Method:This ‘How I Do It’ paper describes and illustrates the use of an alternative curved adjustable fibre-optic diode laser in microscopic cholesteatoma surgery.Results:The curved, adjustable laser fibre allows accurate and atraumatic disease removal when the use of a straight laser fibre may be less effective or accurate. It reduces potential damage to delicate structures without the need for extra drilling or bone removal.Conclusion:It is suggested that the curved adjustable laser fibre is superior to the traditional straight fibre for cholesteatoma surgery.

Safety Study of Photodynamic Therapy Using Talaporfin Sodium in the Pancreas and Surrounding Tissues in the Syrian Golden Hamster

Aim. To assess the safety of photodynamic therapy (PDT) using talaporfin sodium on the pancreas and surrounding organs in normal hamsters.Methods. Fluorescence microscopy documented talaporfin levels in liver, duodenum, and pancreas up to 24 hours after photosensitisation. Lesion size in liver 3 days after PDT (50 J, 5 mg/kg, variable drug-light interval (DLI)) was documented to optimise the DLI. Using optimum DLI, pancreas and surrounding organs were treated with laser fibre touching the surface and animals were killed at 3 or 21 days.Results. Peak fluorescence was seen in duodenum and pancreas at 15 mins (second lower peak at 2 hours). Liver fluorescence was consistently high (peak 1 hour) until after 4 hours. Optimum DLI was seen at 15 minutes. The pancreas was relatively resistant to direct PDT injury (small lesions at high doses) but surrounding stomach, duodenum, and liver were more susceptible with evidence of adhesions and full thickness damage (localised peritonitis and duodenal perforation at highest doses).Conclusion. The safety profile is similar to PDT with longer acting photosensitisers. The pancreas appears safe to treat, but care is required to avoid high light doses to the intestinal tract, particularly the duodenum.