Selection of 1.94-µm thulium fiber laser parameters for the submucosal coagulation of the inferior turbinates

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BACKGROUND: Medical treatment often provides only short-term relief and is ineffective in many cases. Although surgical interventions for vasomotor rhinitis are effective, they are also associated with significant bleeding, nasal tamponade, and hospitalization.

AIM: This study aimed to determine the optimal parameters for laser treatment using a 1.94-µm wavelength on nasal turbinates in vasomotor rhinitis.

MATERIALS AND METHODS: The coagulation potential of the 1.94-µm wavelength on calf kidney tissue was investigated to guide the selection of laser parameters for nasal turbinates. Interstitial coagulation was performed on calf kidney tissue at power levels ranging from 1 to 5 W, with an interval of 1 W. The fiber movement speed was set at 4 mm/s. Each power level was tested five times for statistical analysis, and 10 samples were obtained for histological assessment.

RESULTS: With interstitial exposure, the largest coagulation area was observed at 3 W, and the overall diameter of the effect was on average 2.57 ± 0.1 mm.

CONCLUSIONS: The optimal balance between coagulation and ablation was achieved at a power level of 3 W during interstitial exposure.

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作者简介

Sergey Karpishchenko

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: karpischenkos@mail.ru
ORCID iD: 0000-0003-1124-1937
SPIN 代码: 1254-0263

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Marina Ryabova

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: marinaryabova@mail.ru
ORCID iD: 0000-0002-6714-9454
SPIN 代码: 3951-7190

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Mikxail Ulupov

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: mike.ulupov@gmail.com
ORCID iD: 0000-0002-8460-9889
SPIN 代码: 1851-8202

MD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Saint Petersburg

Galina Yukina

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: pipson@inbox.ru
ORCID iD: 0000-0001-8888-4135
SPIN 代码: 2533-2084

Assistant Professor

俄罗斯联邦, Saint Petersburg

Elena Sukhorukova

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: len48@inbox.ru
ORCID iD: 0000-0001-5521-7248
SPIN 代码: 2115-9041
俄罗斯联邦, Saint Petersburg

Jakhongir Rakhmonov

Academician I.P. Pavlov First Saint Petersburg State Medical University

编辑信件的主要联系方式.
Email: janik.27@mail.ru
ORCID iD: 0009-0005-9176-0156

Postgraduate student

俄罗斯联邦, Saint Petersburg

参考

  1. Aref’eva NA, Vishnyakov VV, Karpishchenko SA, et al. Vasomotor rhinitis: pathogenesis, diagnosis and principles of treatment. Clinical recommendations. Moscow, 2014. 25 p. (In Russ.) EDN: SBUFCA
  2. Segboer C, Gevorgyan A, Avdeeva K, et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev. 2019;2019(11):CD010592. doi: 10.1002/14651858.CD010592.pub2
  3. Abdullah B, Singh S. Surgical interventions for inferior turbinate hypertrophy: a comprehensive review of current techniques and technologies. Int J Environ Res Public Health. 2021;18(7):3441. doi: 10.3390/ijerph18073441
  4. Karpishchenko SA, Ryabova MA, Ulupov MY. Laser surgery in otolaryngology at the present stage. Consilium Medicum. 2014;16(11):73–76. EDN: TESNBT
  5. Karpishchenko SA, Riabova MA, Ulupov MYu, et al. The choice of parameters for the laser application in ENT surgery. Russian Bulletin of Otorhinolaryngology. 2016;81(4):14–18. EDN: WHZZXR doi: 10.17116/otorino201681414-18
  6. Lau K, Stavrakas M, Ray J. Lasers in rhinology: an update. Ear Nose Throat J. 2021;100(1_suppl):77S–82S. doi: 10.1177/0145561320940115
  7. Kang SH, Lim S, Oh D, et al. Clinical feasibility trial of 1,940-nm diode laser in Korean patients with inferior turbinate hypertrophy. Medical Lasers. 2015;4(2):60–64. doi: 10.25289/ML.2015.4.2.60
  8. Ryabova MA, Ulupov MY, Shumilova NA, et al. Possibilities of sparing surgical treatment of vasomotor rhinitis in elderly. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2020;26(4):50–58. EDN: BLEEVM doi: 10.33848/foliorl23103825-2020-26-4-50-58
  9. Sroka R, Havel M, Betz C, et al. Clinical feasibility trial on 1940 nm Tm: fiber laser intervention of hyperplastic inferior nasal turbinates. Photonics Lasers Med. 2012;1(3):215–222. doi: 10.1515/plm-2012-0021
  10. Anderson M, Liang J. Trends in inferior turbinate surgery: analysis of patients using the Medicare database. Int Forum Allergy Rhinol. 2018;8(10):1169–1174. doi: 10.1002/alr.22169
  11. Ryabova MA, Ulupov MYu, Shumilova NA, et al. Comparison of cutting and coagulation properties of 1.56 and 1.94 µm fiber lasers and 0.98 µm semiconductor laser. Bulletin of Siberian Medicine. 2021;20(4):56–62. EDN: TIMMAW doi: 10.20538/1682-0363-2021-4-56-62
  12. Shakhnazarov AE, Lavrenova GV, Gaskova PI. Treatment of vasomotor rhinitis with liquid nitrogen. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2022;28(2):72–78. EDN: AOHCDY doi: 10.33848/foliorl23103825-2022-28-2-72-78

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2. Fig. 5. Coagulation thickness as a function of power

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3. Fig. 1. Schematic of the damage

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4. Fig. 2. Microscopic picture of pathologic changes in the biological tissue (calf kidney) after laser interstitial exposure to 1.94-µm wavelength laser: (а) 1 W, (b) 2 W, (c) 3 W, (d) 4 W, and (e) 5 W. Blue line, ablation zone; red line, ablation and coagulation zones

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5. Fig. 3. Diameter of total tissue damage as a function of power

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6. Fig. 4. Ablation zone diameter depending on power

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7. Fig. 5. Coagulation thickness as a function of power

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