Diode Laser Surgery
Diode sources at 980, 1470 and 1940 nm for soft-tissue surgery, urology and proctology
Diode lasers cut, vaporize and coagulate soft tissue through optical fibers, enabling minimally invasive procedures with little bleeding. The effect on tissue depends on wavelength: at 980 nm hemoglobin and water absorb, and coagulation is deep and highly hemostatic; at 1470 nm water absorption is much higher and vaporization is shallower and more controlled; at 1940 nm water absorption is nearly a thousand times higher than at 1064 nm, allowing precise ablation with a minimal coagulation margin [7]. Combining several wavelengths in one device makes it possible to tune the balance between cutting and hemostasis.
Urology: prostate vaporization
In benign prostatic hyperplasia, obstructive tissue is vaporized transurethrally with a side-firing fiber. Vaporization with a 980 nm diode improves symptoms and urinary flow without the need for transfusion [1] and, in the medium term, provides functional results comparable to the 532 nm green laser, although its deeper coagulation is associated with more necrotic tissue and reoperations [2]. Devices combining 980 nm and 1470 nm aim to balance hemostasis and vaporization [3].
| Parameter | Reference value |
|---|---|
| Power (CW) | 150–200 W at 980 nm [1, 2] · 100–110 W with a combined 980 + 1470 nm source [3] |
| Fiber | Side-firing [1] · conical tip [3] |
We can develop fiber-coupled 980 nm diode sources of up to 200 W, and combine them with 1470 nm in a single source.
Proctology
Laser hemorrhoidoplasty and laser closure of perianal fistulas are performed with fibers inserted into the tissue, at 1470 nm and at low power. Compared with conventional hemorrhoidectomy, laser hemorrhoidoplasty reduces bleeding, operative time and postoperative pain [4].
| Parameter | Hemorrhoidoplasty (1470 nm) | Fistula closure (1470 nm) |
|---|---|---|
| Power (CW) | 6–10 W [5] | 12 W [6] |
| Application | 1–3 s pulses; 8 W for 3 s coagulates about 4 mm of tissue [5] | Radial fiber withdrawn along the tract [6] |
Our fiber-coupled 1470 nm diode bars cover these power levels.
Precision cutting at 1940 nm
At 1940 nm the radiation is absorbed in a very thin layer of tissue. In experimental spleen surgery, cutting at 1940 nm produces a thermal damage zone of about 0.66 mm, compared with 1.4 mm at 1470 nm, with equally effective hemostasis [8]. In endobronchial therapy it has been applied safely at powers of 5 to 20 W [7]. These studies use thulium fiber lasers; tissue interaction is determined by wavelength, and 1940 nm diodes offer a more compact alternative.
For low-power applications, we can develop fiber-coupled 1940 nm diode sources, on their own or combined with 980 nm and 1470 nm.
References
1. Chen CH, Chiang PH, Chuang YC, Lee WC, Chen YT, Lee WC. Preliminary results of prostate vaporization in the treatment of benign prostatic hyperplasia by using a 200-W high-intensity diode laser. Urology. 2010;75(3):658–663. doi:10.1016/j.urology.2009.09.033
2. Guo S, Müller G, Bonkat G, Püschel H, Gasser T, Bachmann A, et al. GreenLight laser vs diode laser vaporization of the prostate: 3-year results of a prospective nonrandomized study. J Endourol. 2015;29(4):449–454. doi:10.1089/end.2014.0572
3. Beltrami P, Guttilla A, Fumo G, Zattoni F, Vianello F, Cecchetti L, et al. Treating cervico-urethral obstructions with laser diode: initial clinical experience [en italiano]. Urologia. 2012;79(Suppl 19):58–66. doi:10.5301/RU.2012.9734
4. Cheng PL, Chen CC, Chen JS, Wei PL, Huang YJ. Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: meta-analysis. Asian J Surg. 2024;47(11):4681–4690. doi:10.1016/j.asjsur.2024.04.156
5. Danys D, Pacevicius J, Makunaite G, Palubeckas R, Mainelis A, Markevicius N, et al. Tissue coagulation in laser hemorrhoidoplasty — an experimental study. Open Med (Wars). 2020;15:185–189. doi:10.1515/med-2020-0027
6. Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F. Closing perianal fistulas using a laser: long-term results in 103 patients. Dis Colon Rectum. 2018;61(5):599–603. doi:10.1097/DCR.0000000000001038
7. Gesierich W, Reichenberger F, Fertl A, Haeussinger K, Sroka R. Endobronchial therapy with a thulium fiber laser (1940 nm). J Thorac Cardiovasc Surg. 2014;147(6):1827–1832. doi:10.1016/j.jtcvs.2013.12.038
8. Żywicka B, Rybak Z, Janeczek M, Czerski A, Bujok J, Szymonowicz M, et al. Comparison of a 1940 nm thulium-doped fiber laser and a 1470 nm diode laser for cutting efficacy and hemostasis in a pig model of spleen surgery. Materials (Basel). 2020;13(5):1167. doi:10.3390/ma13051167
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