Flexible-fiber CO2 laser proves safe in endoscopic endonasal transsphenoidal surgery

A flexible-fiber CO₂ laser can safely cut and coagulate during endoscopic-assisted transsphenoidal craniotomies (TSC) without the line-of-sight problems encountered with conventional CO₂ lasers, according to a study from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM; both of Boston, MA).

The study's findings appear in the July/August issue of World Neurosurgery, and mark the first reported flexible-fiber CO₂ laser-assisted ablation in TSC. In the study, the researchers performed a retrospective chart review on 16 patients who underwent flexible-fiber CO₂ laser-assisted endoscopic ESS. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications and resection rates. Pituitary lesions with an average size of 22.7 mm were identified by radiographic and pathologic criteria. The researchers found surgery had a low rate of complication and no laser-related complications were encountered.

The authors note that the use of flexible-fiber CO₂ lasers in ESS is ideal because of the small working space, the propensity for bleeding, and the amount of soft tissue and osteogenic dissection involved.

But because this is a feasibility and safety study, the authors cannot draw any conclusions regarding outcomes compared with traditional endoscopic transsphenoidal methods, including any difference in time required for laser surgery. However, as their experience has increased, they have seen improved time efficiency with regard to laser setup and use.

"The flexible-fiber CO₂ laser tool described and utilized in this report is ideally suited for endoscopic-assisted TSC because of the narrow corridors and difficulty in using conventional cutting and coagulating instruments," says study co-author author Anand K. Devaiah, MD, FACS, an otolaryngologist at BMC and associate professor of otolaryngology and neurological surgery at BUSM. Devaiah has worked extensively with this system in pioneering applications for minimally invasive surgery, and works with the CO₂ laser fiber company, OmniGuide, as a consultant. "Because most pituitary tumors are soft, the CO₂ laser was not used extensively for tumor resection in this series, but we have found it very helpful in removing recurrent pituitary adenomas where tumor consistency is often more fibrous and dural scarring may be extensive," adds Devaiah.

"Further study of this promising surgical tool is being investigated in other areas of neurosurgery, including tumors of the brains and spinal cord," says senior author Lawrence Chin, MD, chief of neurosurgery at BMC and professor and chairman of neurosurgery at BUSM.

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