A novel ultrasmall composite optical fiberscope.

BACKGROUND: Accurately aiming laser energy at a target from a two-dimensional endoscopic view is difficult during endoscopic laser surgery, particularly when the endoscope and the laser fiber are misaligned. We developed a composite optical fiberscope (COF) that can simultaneously visualize a target area and perform laser irradiation. The identical orientation of the endoscope and the laser fiber allows intuitive aiming at a target, even from a two-dimensional endoscopic view. METHODS: We developed an ultrasmall COF (1.1-mm diameter) with a central cauterizing laser fiber surrounded by imaging and illumination fibers as a tool for various surgical applications. Porcine mesenteric blood vessels were laser irradiated in vivo and the procedure was filmed using ultrahigh-speed (max 1,000,000 frames per second) and thermographic cameras. Blood flow and vessel diameters were measured before and after laser irradiation. RESULTS: The target vessels were highly visible and laser energy was delivered to the center of the view. Images from the ultrahigh-speed camera showed the blocking of the target vessel by the laser irradiation. The irradiated point initially became constricted, then discolored, and then decreased in size. Blood flow was decreased by 81.7% after laser irradiation and the diameter of the vessels at the irradiated point was approximately 46-48% smaller than that of the unirradiated vessels. Medical doctors also confirmed that the blood vessel was blocked after the experiments. CONCLUSIONS: Our new laser surgery device may be useful for many surgical applications because it allows simultaneous diagnosis and treatment as well as intuitive aiming at a target despite its ultrasmall 1.1-mm diameter.

The development of a composite-type optical fiberscope system for fetoscopic laser photocoagulation of chorionic plate anastomosing vessels (FLPC).

We developed a new laser device using a composite-type optical fiberscope for laser surgery to treat twin-twin transfusion syndrome. The composite-type optical fiberscope (2.2 mm in external diameter) consists of a centrally located single fiber for laser treatment (0.1 mm in diameter) and its surrounding fibers for diagnosis. This fiberscope enables transmission of 40-W Yb fiber laser. The Yb fiber laser can be focused to 10mm focal length using two lenses on the tip of the fiberscope. In this research, we emitted the laser to in vivo porcine mesenteric vessel with blood flow both with an established laser fiber of 0.6-mm diameter (0.6-mm normal fiber) and with our composite-type optical fiberscope to compare the cautery performance of those devices. According to the experimental results, the composite-type optical fiberscope has a cautery efficiency equal to that of a 0.6-mm normal fiber, and it can contract the vein diameter about 35% as compared to the vein diameter before laser irradiation.

Blood flow measurement system for fetoscopic laser photocoagulation of chorionic plate anastomosing vessels (FLPC).

Fetoscopic laser photocoagulation of chorionic plate anastomosing vessels (FLPC) applies to the treatment of previable fetuses with severe twin-twin transfusion syndrome (TTTS). The ultimate goal of FLPC is selective blood flow interruption of anastomotic communicating vessels on the placenta fetoscopically. However, there has not been an established method to confirm that the blood flow is blocked, thus, it depends on the operator's experience or intuition to evaluate whether the FLPC was performed successfully or not. For this issue, we have developed a composite-type optical fiberscope (2.2 mm in diameter), which has centrally-located cautery laser fiber and surrounding located fiberglasses for viewing. This fiberscope enables transmission of 50 W Yb fiber laser which can be focused to 10 mm focal length using two lenses on the fiberscope tip. In this study, we combined the fiberscope and a laser blood-flow meter, and irradiated cautery laser to porcine mesenteric vein with measuring blood flow at the same time. From the experimental results, we could quantitatively measure the blood flow before and after laser irradiation, and confirm the blood flow blocking with our system.