A new modality for minimally invasive CO2 laser surgery: flexible hollow-core photonic bandgap fibers.

Carbon dioxide (CO2) lasers have become one of the most common surgical lasers due to excellent tissue interaction properties that offer precise control of cutting and ablation depth, minimal thermal damage to surrounding tissue, and good hemostasis. However, realization of the benefits offered by using surgical CO2 lasers in many endoscopic, minimally invasive surgical procedures has been inhibited by the absence of reliable, flexible fiber laser beam delivery systems. Recently, novel hollow-core photonic bandgap optical fibers for CO2 lasers were developed that offer high flexibility and mechanical robustness with good optical performance under tight bends. These fibers can be used through rigid and flexible endoscopes and various handpieces and will allow surgeons to perform delicate and precise laser surgery procedures in a minimally invasive manner. This paper describes the basic design of laser beam delivery system, different surgical fiber designs and their characteristics, and usage with existing surgical CO2 laser models. A few examples of successful CO2 laser surgeries performed with these fibers are presented.