The use of Thulium-Doped Fiber Laser (TDFL) 1940 nm as an energy device in liver parenchyma resection, a-pilot-study in Indonesia

Abstract

Introduction: Several modalities are used to improve the outcome of liver resection surgery. Laser-based surgery may become promising option; therefore we aim to report our experience regarding the efficacy and safety of Thulium-Doped Fiber Laser (TDFL) 1940 nm in liver parenchyma resection.

Methods: A cross sectional study in which patients with pre-existing liver pathology during July 2019 and July 2020 were randomly assigned to receive liver resection using TDFL integrated with raman laser emitting at 1940 nm and 1470 nm wavelength. Data on estimated blood loss during liver transection, liver transection speed, morbidity rate, and postoperative variables including complications, length of hospital stay (days), and mortality were analyzed.

Results: A total of 17 consecutive liver resections were performed, among them are 7 major and 11 minor hepatectomies. The Multipulse TM+1470 were used on 8 procedures consisted of 1 major and 7 minor hepatectomies, the mean amount of blood loss during operation and liver transection was 628.13 ± 141.31 mL and 294.63 ± 94.81 ml, respectively. The mean liver transection speed was 1.52 ± 0.27 cm²/min. No biliary leak, post-hepatectomy-liver failure, and mortality were reported.

Conclusion: TDFL provided by Multipulse TM+1470 is an effective and safe tool for liver surgery, providing good hemostasis and allowing for safe and effective exposure of vascular. Further study with larger samples might be needed proved the efficacy and safety of TDFL in liver surgery.

Keywords: Laser-based surgery; Liver resection; Liver surgery; Thulium-doped fiber laser.

Fig. 1

A. The Multipulse TM +1470 nm emitting the Thulium laser at 1940 nm and Raman laser at 1470 nm, B. The TDFL being used by the author as an energy device to perform liver parenchyma resection.

Fig. 2

A. The TDFL cutting function in Systematic Extended Right Posterior Sectionectomy (SERPS), the minuscule tip of laser fiber (*) able to cut the parenchyma with close proximity to major vascular and biliary structures, B. The coagulation function (**) for hemostasis from the raw liver surface, C. The liver parenchyma transected plane (***) by TDFL showed excellent hemostasis and no bile leakage.