Lisa Laser USA

The following information was presented at the American Urological Association Annual Meeting in San Antonio, TX, in May 2005 by Matthew H. Bui, Alberto Breda and Peter G. Schulam.

Objective:

Laparoscopic partial nephrectomy is technically challenging from the
standpoint of hemostatic control, often requiring extensive manipulation and control of the renal
vascular hilum. We evaluated the utility of the Revolix™ laser, a novel continuous wave laser, for
laparoscopic partial nephrectomy without hilar clamping in a porcine model.

Methods:

Laparoscopic transperitoneal lower pole partial nephrectomy was performed in 4 Yorkshire farm pigs without
manipulation or clamping of the renal hilum. All animals underwent a left-sided laparoscopic partial nephrectomy and were kept alive for 1 week. Subsequently, a left laparoscopic nephrectomy was performed, and the animals were sacrificed. Using the Revolix laser, an end-fire and a side-fire 271-micron laser fiber set at 15 watts were used to produce full-thickness cortical excisions of the lower pole renal cortex. The cut parenchymal surface was evaluated for hemostasis. The cut surface was then sealed with fibrin glue. The harvested kidneys were inspected grossly and evaluated microscopically.

Results:

Laparoscopic partial nephrectomy was successfully completed in all cases. There were no perioperative complications in the survival group with an estimated blood loss of less than 50 cc. The Revolix end-fire and side-fire laser afforded precise dissection without tissue charring. The Revolix laser was able to seal vessels up to 1.5 mm in size. In the survival group, serum creatinine levels showed no significant changes post-operatively.

Conclusions:

The novel continuous wave Revolix™ laser provides excellent hemostatic control for precise dissection of the renal cortex without vascular hilum clamping. For use in humans, this laser would be well suited for laparoscopic excision of exophytic lesions limited to the renal cortex.

The following information was presented at the 2005 European Respiratory Society Annual Congress by Franz Stanzel, Peter Raasch and Karl Haeussinger.

Body:

Airway recanalization in advanced cancers is one of the intervetional procedures of daily routine nowadays. Beside the Nd:YAG laser electrocoagulation and especially APC are widespread. Coagulation and hemostasis seem to be sometimes only suboptimal. A new 2 continuous wave DPSS laser (Revolix ) combines cutting and ablation advantages and achieves excellent hemostasis.

We carried out a pilot sudy in 23 patients (15 male, 8 female) suffering from lung cancer (19), typical carcinoid (3), or lipoma (1) with central airway obstruction and retention pneumonia. All patients had total or subtotal obstruction of the trachea (5), main stem bronchi (15) or lobar bronchi (10). We used the Revolix for ablation of obstructing tumour masses in 35 bronchoscopies. The power setting was 5 - 15 W, pulsed or continuous, by flexible bare terminated or compressed air cooled fibres.

In 20 out of 23 patients airway patency could be established. In 3 cases the stenosis was too long exceeding to the subsegmental level. Ablation was faster, hemostasis more effective, and power was lower compared to the Nd:YAG laser. There was no need of changing to Nd:YAG or APC. We recommend the cooled fibre because of a risk of fire when using the bare fibre. We saw no patient complications, but one bronchoscope damage (coagulation of the tip).

The Revolix is a very effective and fast tool for airway recanalization. It is safe when the cooled fibre is used. It may replace the Nd:YAG laser because of the better hemostasis and the better calculable tissue effect.