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University of Groningen the CO2 Laser in Tumor Surgery Verschueren University of Groningen The CO2 laser in tumor surgery Verschueren, René Camille Jean IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 1976 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Verschueren, R. C. J. (1976). The CO2 laser in tumor surgery. [s.n.]. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 26-09-2021 THE CO:�. LASER IN TUMOR SURGERY STELLINGEN 1. Het panantmm moet behandeld worden met de principes van de abcestherapie: directe benadering, evacuatie van pus en excisie van necrotisch weefsel. 2. De resultaten van Esperal implantatie bij alcoholici zijn mogelijk te wijten aan het placebo-effect. 3. Fasciltis necroticans is het resultaat van een circulus viciosus: weefsel­ ischemie, infectie en verminderde weerstand van de patient (Brit. J.Surg.62: 364, 1975). 4. Bij de zogenaamde cryoliethverbrandingen is de chemische etsing te verwaarlozen, ze moeten als thermische laesies beschouwd worden. 5. Voor een juiste informatie en voor het gemak van de niet met vogel­ eieren en fruitsoorten vertrouwde collegae is het noodzakelijk de af­ metingen van gezwellen aan te geven in centimeters (Ca 25 : 112, 1975). 6. Bij een polytraumatise met shock dient het belang van de radiolo­ gische diagnostiek te worden afgewogen tegen de risico's van het uitstellen der exploratieve laparotomie. 7. Het te hooi en te gras gebruiken van nieuwe technieken zoals de C02 laser kan deze modaliteiten in discrediet brengen. 8. Bij tumoren in het hoofd hals gebied moet in het algemeen locale genezing worden nagestreefd afgezien van het feit of de patient al dan niet te curreren is. 9. Het is waarschijnlijk dat lymfocytaire infiltratie random een primair malign melanoblastoom prognostisch een gunstig teken is. Ge­ standaardiseerde quantificering van deze lymfocytaire reactie en prospectief onderzoek zijn wenselijk. 10. Regionale anaesthesie is voor allerlei ingrepen een goed alternatief voor narcose. Het verdient dan ook aanbeveling anaesthesisten hierin op te leiden. 1.1. Het via de nieuwsmedia ter discussie brengen van indicaties voor passieve euthanasie geeft weinig informatie aan het publiek maar kan vee! onrust verwekken bij familieleden van deze patienten. 12. Bezinning over bet voorschrijven van dieten en geneesmiddelen is noodzakelijk. 13. Het rontgenbeeld van een secundaire veretterende kaakcyste kan gemakkelijk als dat van een malign proces worden ge"interpreteerd. 14. Het wordt tijd dat een enquete wordt gehouden naar de wensen van patienten aangaande kledij en haardracht van de 'jonge dokters'. Stellingen behorende bij R. Verschueren, The C02 laser in tumor surgery Groningen 1976 RIJKS UNIYERSITEIT TE GRONING EN THE C02 LASER IN TUMOR SURGERY PROEFSCHRIFT ter verkrijging van het doctoraat in de Geneeskunde aan de Rijksuniversiteit te Groningen op gezag van de Rector Magnificus Dr. M. J. JANSSEN in het openbaar te verdedigen op woensdag 25 februari 1976 des namiddags te 4.00 uurdoor RENE CAMILLE JEAN VERSCHUEREN geboren te Dendermonde 1976 VAN GORCUM & COMP. B.V. ASSEN f AMSTERDAM PROMOTORES: PROF. DR. J. OLDHOFF PROF. DR. Jw. VAN DENBERG CO-REFERENT: DR. J. KO UDSTAAL To Hilda VOORWOORD Bij het verschijnen van dit proefschrift wil ik een woord van dank richten tot degenen die bijgedragen hebben tot mijn opleiding en tot het afronden van dit onderzoek. Allereerst wil ik Dr Vandekerckhove van het St Bartholomeus ziekenhuis in Merksem, Professor Dr. P. J. Kuijjer en de staf van de Groningse Chirurgische Kliniek, danken voor de genoten chirurgische opleiding. Hooggeleerde Oldhoff, hooggeachte promotor, U was het die het laser avontuur startte, mij gedurende deze jaren ruggesteunde en de financiele problemen wist op te lossen. Hooggeleerde Van den Berg, hooggeachte promotor, ik ben U dankbaar voor de vaste hand die mij leidde langs het moeilijke pad van het weten­ schappelijk denken en exact fo rmuleren. Zeergeleerde Koudstaal, geachte coreferent, zonder Uw eindeloos geduld was ik er niet in geslaagd het probleem van de weefselbeschadiging op te Iossen. De histochemische preparaten werden vervaardigd door de afdeling Histochemie van het Pathologisch Anatomisch Laboratorium, hoofd Dr. M. J. Hardonk. Geachte juffrouw Haarsma, het monnikenwerk van de kleuring van enkele duizenden coupes hebt U met enthousiasme volbracht. Geachte Shirvill, beste Fred, jij zuiverde mijn manuscript van de minder Engels klinkende uitdrukkingen. Geleerde Vermey, zeergeleerde Schraffordt Koops en geleerde Van der Ploeg, jullie accepteerden dat het experimenteel werk in de voorbije periode een groot dee) van mijn tijd in beslag nam. Ik hoop dat we nog lang kunnen blijven samenwerken. Subsidies van het Preventiefonds en van de stichting K.W.F.-N.O.K. stelden mijfinancieel in staat dit onderzoek uit te voeren. Vele anderen spanden zich in voor dit onderzoek : - Dr. Visser en Dr. Rogge beoordeelden rontgenopnamen van femur osteotomien. VII - Drs. Bakker, de heer Elstrodt en de biotechnici van het centraal dieren laboratorium. - De heer Martens en zijn medewerkers van de medische fotodienst. - De heer Swarte hielp technische storingen aan de laser apparaten oplossen. - De heren Kuitert en Prins vervaardigden een laryngoscoop en twee rectoscopen. - De heer Deddens besteedde grote zorg aan de lijntekeningen van dit proefschrift. - Broeder Mein en het personeel van de chirurgische O.K. wens ik te danken voor de genoten gastvrijheid bij de klinische laser operaties. VIII CON TEN TS CHAPTER 1. PURPOSE OF THE INVESTIG ATION 1.1. Laser beams 1.1.1. Introduction 1.1.1.1. Spontaneous emission of light. 2 1.1.1.2. Absorption of light . 3 1.1.1.3. Stimulated emission of light. 3 1.1.2. The RUBY laser. 4 1.1.3. Properties of laser beams . 5 1.1.3.1. Monochromaticity .. .. 5 1.1.3.2. Coherence . 5 1.1.3.3. Energy density and power density 5 1.1.3.4. Focusing a laser beam . 6 1.2. Short historic review of medical applications of laser beams 7 1.3. Purpose and motivation of the investigation. 9 1.3.1. Surgery in highly vascular tissues 9 1.3.1.1. Liver surgery .. 9 1.3.1.2. Spleen surgery . 9 1.3.2. Bone biopsies . 9 1.3.3. Pa lliative surgery in high risk patients . 10 1.3.4. Coagulation of rectal tumors . 10 CHAPTER 2. REQU IREMENTS AND CHOICE OF A SURGICA L LASER . 12 2.1. Requirements a surgical laser has to meet. 12 2.1 .1. Absorption in living tissues. 12 2. 1.2. The absorption of the beam should not be influenced by the colour of the tissue . · · · · · · · 13 2.1 .3. Manoeuvrability of the apparatus. 14 2.1.4. The power output of the laser must be sufficient to vaporize tissues effi- ciently .................... 14 2.1.5. The clinical use of the laser must be technically feasible . 14 IX 2.2 Selection of a convenient surgical laser . 14 CHAPTER 3. THE CARBON DIOXIDE LASER ... 18 3.1. The carbon dioxide laser of the American Optical Corporation 18 3.1.1. Functional description ...... 18 3. 1 .2. Safety measures . 22 3.1.2.1. Protection against reflected laser light 22 3 .1.2.2. Fire hazards and protection of surrounding tissues 23 3.1.2.3. Safeguarding of the machine . 24 3.1.3. Asepsis while performing surgery .. 24 3.2. The Sharplan 791 carbon dioxide laser . 24 3.2.1. Functional description . 24 3.2.2. Safety measures . 28 3.2.3. Asepsis while performing surgery . 28 CHA PTER 4. THERMAL DA MA GE IN ADJO INING TISSUES AFTER USING THE FOCUSED C01 LASER BEAM. 29 4.1. Introduction. 29 4.2. Preliminary observations 31 4.3. Method of investigation . 36 4.4. Results. 38 4.5. Discussion 41 4.5.1 . Thermal damage due to absorption of the beam . 42 4.5.2. Thermal damage due to conduction of heat. 45 4.6. Conclusions . 46 CHAPTER 5. THE US E OF THE C01 LASER AS A LIGHT KNIFE IN PARENCHYMATOUS ORGANS.. 48 5.1. The C01 laser in hepatic surgery . 48 5.1.1. Previous investigations in other centres . 48 5. 1.2. Personal investigations about liver surgery with the C01 laser. 49 5. 1.2.1. Liver surgery in rabbits. 49 5. 1 .2.2. Liver surgery in mongrel dogs . 51 5. 1.3. Tissue necrosis in the liver after the use of the C02 laser as a cutting and a hemostatic instrument . 51 5. 1.3.1. Tissue necrosis after cutting only . 51 X 5.1.3.2. Tissue necrosis after obtaining hemostasis in the proximal cut end by using a defocused laser beam . 51 5.1 .4. Discussion . 52 5.1.5. Conclusions . 53 5.2. The C02 laser in spleen surgery . 54 CHA PTER 6. THE C02 LASER AS AN ORTHOP EDIC INSTRU- MENT FOR BO NE BIOPSIES. 55 6.1. Introduction. 55 6.2. Method of investigation . 56 6.2.1. Preparation of the animal and anaesthesia 56 6.2.2. The laser osteotomy. 57 6.2.3. The conventional osteotomy. 57 6.2.4. Fixation of the bone fragments 57 6.2.5.
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