Endoscopic mucosal incision by diode laser for the early cancer treatment in alimentary tract: Effect of submucosal indocyanine-green-solution injection

Takuya Hayashi, Tsunenori Arai, Naoko Nakamura, Hisao Tajiri, Soichiro Miura, Makoto Kikuchi

Research output: Contribution to journalConference article

1 Citation (Scopus)

Abstract

Mucosal incision technique by diode laser ablation was studied to ensure the operation of endoscopic mucosal resection (EMR), which is gold standard method for early gastric cancer with little/no risk of lymphnode metastasis. Our method was designed to facilitate grasping a large lesion by hitching the snaring wire on the incised mucosal groove around the lesion. We employed local submucosal injection of indocyanine green (ICG) solution (1 mg/ml). ICG solution was used to prevent direct laser light penetration to the musclaris propriae owing to strong absorption of 805 nm light (absorption coefficient at 805 nm is about 200 cm-1). We used diode laser radiation with an output of 25 W by contact (0.1, 0.5, 1.0 kg/cm2) and non-contact irradiation methods. In the preliminary experiment with resected porcine stomach, musclaris propriae was intact by the 60s non-contact irradiation or the 8s contact irradiation with contact pressure of 1 kg/cm2. In the endoscopic experiment we used 3 dogs. Using conical contact probe, we successfully demonstrated 3 cm diameter circular incision with sharp groove in 10 minutes. We could place the snaring wire on the incised groove. Histology of the endoscopically incised canine stomach revealed that the submucosal layer swelled up to 6 mm in thickness and the bottom of the incision groove reached 1.9 mm at deepest below the mucosal muscle. The thickness of the coagulation layer around the incised groove was up to 1.8 mm. No damage was seen at the musclaris propriae. We demonstrated easy as well as sure snaring by using our laser incision technique. We think our technique may be available to enhance the efficacy of EMR for early gastric cancer including the lesion over 2 cm in diameter.

Original languageEnglish
Pages (from-to)425-430
Number of pages6
JournalProceedings of SPIE - The International Society for Optical Engineering
Volume3590
Publication statusPublished - 1999 Jan 1
EventProceedings of the 1999 Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems IX - San Jose, CA, USA
Duration: 1999 Jan 231999 Jan 24

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Condensed Matter Physics
  • Computer Science Applications
  • Applied Mathematics
  • Electrical and Electronic Engineering

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