13CO2 isotopic laser used through the operating channel of laser laparoscopes: a comparative study of power and energy density losses.

Abstract

To evaluate the power transmission, spot size, power density, and energy density of a new isotopic carbon dioxide (13CO2) laser compared with a conventional CO2 laser. Experiments were performed in a laboratory using a conventional CO2 laser and an isotopic 13CO2 laser. Two laparoscopes with 5-mm and 7.5-mm operating channels were connected to a standard coupler and to each of the lasers. Standardized measurements were made of power transmission and spot size using both nitrogen purge gas and CO2 purge gas at rates of 1-20 L/minute. Power density and energy density were calculated for continuous mode and ultrapulse mode transmission, respectively. The isotopic 13CO2 laser power transmission was higher and proportional to input power, while spot size was smaller compared with the conventional laser and was insensitive to power level or purge rate. Power density and energy density were markedly higher with the isotopic 13CO2 laser, reaching the threshold for complete ablation, and were much more predictable. The 7.5-mm operating channel generally had superior operating results compared with the 5-mm channel because of the smaller spot size and higher power transmission. The isotopic 13CO2 laser is associated with much higher power density and energy density capabilities than are conventional CO2 lasers. At surgery, we have noted less thermal injury, faster ablation, more precise and predictable tissue effects, and greater control of tissue effect with the isotopic 13CO2 laser than with other CO2 lasers. These results are attributed to the improved beam propagation through CO2 insufflation gas measured in the laboratory. Thermal injury can be varied according to the required surgical situation and can be kept to an absolute minimum at high-pulse energy.