The ability to use fiber-delivered erbium-laser radiation for non-contact arthroscopic meniscectomy in a liquid environment was studied. The laser radiation is transmitted through a water-vapor channel created by the leading part of the laser pulse. The dynamics of the channel formation around a submerged fiber tip was investigated with time-resolved flash photography. Strong pressure transients with amplitudes up to a few hundreds of bars measured with a needle hydrophone were found to accompany the channel formation process. Additional pressure transients in the range of kbars were observed after the laser pulse associated with the collapse of the vapor channel. Transmission measurements revealed that the duration the laser-induced channel stays open, and therefore the energy transmittable through it, is substantially determined by the laser pulse duration. The optimum pulse duration was found to be in the range between 250 and 350 µS. This was confirmed by histological evaluations of the laser incisions in meniscus: Increasing the pulse duration from 300 to 800 µs leads to a decrease in the crater depth from 1600 to 300 µm. A comparison of the histological examination after laser treatment through air and through water gave information on the influence of the vapor channel on the ablation efficiency, the cutting quality and the induced thermal damage in the adjacent tissue. The study shows that the erbium laser combined with an adequate fiber delivery system represents an effective surgical instrument liable to become increasingly accepted in orthopedic surgery.
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Ith, M., Pratisto, H., Altermatt, H.J. et al. Dynamics of laser-induced channel formation in water and influence of pulse duration on the ablation of biotissue under water with pulsed erbium-laser radiation. Appl. Phys. B 59, 621–629 (1994). https://doi.org/10.1007/BF01081183