Hepatic Resection With an Nd.YAG Laser in Pig

Eleven hepatic resections were performed by means of a divergent Nd:YAG laser. The beam was transmitted through a fiberoptic delivery system without any handpiece. The shortest resection time and most limited ischemic damage (4 mm) were obtained with 80-W power shoots and a low divergent beam (4 degrees 2 for full angle). The hemostatic effects of the Nd:YAG controlled bleeding from veins of up to 4.5 mm in diameter, and parenchymatic oozing from the cut edge minimized blood loss. Histological examination revealed the importance of cellular deterioration in the ischemic layer, while electron microscopy showed selective destruction of cell organelles and protein denaturation. Marked elevation of hepatic serum enzymes suggests a high degree of cellular damage. Postoperative examinations confirmed an uncomplicated healing process. Finally, the use of a flexible fiberoptic enables easy surgical manipulation.