Thermal Effects of CO2, KTP, and Blue Lasers with a Flexible Fiber Delivery System on Vocal Folds

Anouk S Schimberg; Gijs T N Heldens; Tim M Klabbers; Adriana C H van Engen-Van Grunsven; Rudolf M Verdaasdonk; Robert P Takes; David J Wellenstein; Guido B van den Broek

doi:10.1016/j.jvoice.2022.03.006

Thermal Effects of CO₂, KTP, and Blue Lasers with a Flexible Fiber Delivery System on Vocal Folds

J Voice. 2022 Apr 10:S0892-1997(22)00074-1. doi: 10.1016/j.jvoice.2022.03.006. Online ahead of print.

Authors

Anouk S Schimberg¹, Gijs T N Heldens², Tim M Klabbers², Adriana C H van Engen-Van Grunsven³, Rudolf M Verdaasdonk⁴, Robert P Takes², David J Wellenstein², Guido B van den Broek²

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Anouk.Schimberg@radboudumc.nl.
² Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Department of Science and Technology, University of Twente, Enschede, The Netherlands.

PMID: 35418349
DOI: 10.1016/j.jvoice.2022.03.006

Abstract

Objective: To determine the differences in thermal effects on vocal folds between four fiber-routed lasers.

Methods: In this experimental laboratory study the thermal effects of an AcuPulse Duo CO₂ (CO₂ AP), UltraPulse Duo CO₂ (CO₂ UP), KTP, and Blue laser were analyzed using a Schlieren technique on a human tissue mimicking gel model. Power, laser duration, laser fiber distance to tissue and mode (continuous wave [CW] vs pulsed [P] modes) were evaluated in varying combinations in order to compare the effects of the tested lasers and to explore the individual effect on thermal expansion and incision depth of each setting. The model was validated by comparing the results from the Schlieren model with histology of ex vivo fresh human vocal folds after laser irradiation using a selection of the same laser settings, and calculating the intraclass correlation coefficient (ICC).

Results: One thousand ninety-eight Schlieren experiments and 56 vocal cord experiments were conducted. In comparison with CW mode, less thermal expansion occurred in P mode in all lasers, while incisions were deeper in the CO₂ and more superficial in the KTP and Blue lasers. The mean thermal expansion was found to be minimally smaller, whereas incision depth was pronouncedly smaller in the KTP and Blue compared to the CO₂ lasers. Duration of laser irradiation was the most important factor of influence on thermal expansion and incision depth for all lasers in both CW and P modes. The ICC for consistency between the results of the Schlieren model and the vocal cord histology was classified from fair to excellent, except for the thermal expansion of the Blue laser, which was classified as poor.

Conclusion: This study demonstrates important differences in thermal effects between CO₂, KTP, and Blue lasers which can be explained by the different physical characteristics of the P modes and divergence of the fiber delivery system. The Schlieren imaging model is a good predictor of the relative thermal effects in vocal fold tissue. Our results can be used as a guidance for ENT surgeons using fiber-routed lasers, in order to achieve effective treatment of vocal fold lesions and prevention of functional impairment of vocal folds.

Keywords: Flexible endoscopic laser—Thermal effects—Vocal folds.