Safety Concerns of the CO 2 Laser in Traditional and Hand-Held Modes in Transoral Laser Microsurgery

Abstract

Objectives:

Comparisons between line-of-sight and fiber-optic carbon dioxide (CO2) lasers have not been previously reported in regards to interactions with commonly used products in transoral laser microsurgery. In this study we sought to address this gap.

Methods:

The beams of a traditional and an Omniguide fiber-based laser were focused on commonly used materials in transoral laser microsurgery. Three laser resistant endotracheal tubes (ETTs), a standard polyvinylcholoride (PVC) ETT, and cottonoids were evaluated. The time to penetrate through the material was recorded.

Results:

Neither laser beam completely penetrated any of the laser resistant ETTs within 90s of contact. However, both instantaneously perforated the absorbent coating of the laser resistant tubes, immediately exposing the underlying metal tape. The traditional laser perforated the PVC endotracheal tube at 0s, and the Omniguide laser did so within 3s. The Rusch Lasertubus ETT balloon cuff was the most resistant material to both lasers. Both laser beams perforated dry cottonoids instantaneously but were unable to penetrate excessively saturated cottonoids.

Conclusions:

In general the time to penetrate materials was longer for a traditional CO2 laser when used at the same power. The absorbent outer coating of all ETTs was easily penetrated with the laser, revealing highly reflective metallic tape. While supersaturated cottonoids were resistant to both lasers, dry pledgets could be penetrated. Of all ETTs tested, the Rusch Lasertubus ETT appears to be the most resistant to both lasers.