Biomedical Engineering Reference
In-Depth Information
(
A
)
(
B
)
Figure 14.1
(
A
) Preoperative and (
B
) 3-month postoperative view of the abdomen treated with laser lipolysis using the dual 924/975-nm device. The 46-year-old
woman was treated with a total of 60 kJ using a 1.5-mm quartz rod for energy delivery. The fi rst pass was treated with 20 W at 924 nm and 10 W at 975 nm. Second
and third passes were completed at 20 W using the 924-nm wavelength only. Two lipoaspiration passes were completed; the fi rst pass after the fi rst laser pass and the
second pass following second laser pass. Total volume of aspirated fat was 820 cc.
Apfelberg and colleagues reported in 1994 on the fi rst 1064-
nm laser device for use in LAL. In a clinical trial intended for a
new device application to the FDA, this study consisted of 51
patients treated with a 1064-nm Nd:YAG laser (Heraeus Laser-
sonics, acquired by Laserscope Inc., San Jose, California, USA)
during liposuction. Fifteen of these patients had split area
treatment with LAL and conventional liposuction (7). The sys-
tem incorporated a 600-µm fi ber contained within a 4- or
6-mm cannula. A chilled saline infusion was required to fl ow
through the cannula chamber to cool the tip during the proce-
dure. No clear benefi t for LAL was demonstrated in terms of
clinical improvement or patient discomfort (7). Furthermore,
no statistically signifi cant difference was found in postopera-
tive edema or ecchymosis between either treatment side,
although there was a trend toward superior results on the
LAL-treated side (6). Although the device may have reduced
surgeon fatigue during the procedure, the fi ve participating
physicians commented the system was cumbersome to utilize
(7). Given the lack of benefi t of LAL using this YAG laser, the
FDA approval of this device was not pursued.
In October 2006, the SmartLipo™ device (Cynosure Inc.;
DEKA, Calenzano, Italy) gained FDA approval for the “surgi-
cal incision, excision, vaporization, ablation, and coagulation
of soft tissues” as well as for LAL (14,15). The 1064-nm
Nd:YAG SmartLipo device currently delivers a maximum
energy of 18 W, increased from the original 6-W output. The
optical fi ber has been increased from 300 to 600 µm, and treat-
ment is usually administered at 150 mJ/pulse, 40 Hz, with a
100-ms pulse width (14).
As the SmartLipo device has been on the market the longest,
the largest body of published literature accompanies this laser
wavelength. Two studies have observed high patient satisfac-
tion following treatment with this 1064-nm Nd:YAG platform.
Dudelzak performed LAL on the arms of 20 patients with a
10-W, 300-µm fi ber encased in 1-mm microcannula (39). The
liquefi ed fat was removed via standard liposuction aspiration
in 50% of patients. All patients were “very satisfi ed” with their
results despite modest arm circumference reductions that did
not differ from traditional liposculpture. Treatment with and
without post-LAL suction aspiration produced similar results.
Lack (40), in a comparative cohort study of 46 patients, found
patients had higher treatment satisfaction scores with the
1064-nm device compared with tumescent liposuction, and
another study demonstrated a 37% subject-rated improve-
ment 3 months following LAL (18).
Several other studies have examined the safety and effi cacy
of LAL using the 1064-nm wavelength. In a noncomparative
study of 245 patients undergoing LAL, Badin and colleagues
found less trauma, bleeding, and swelling after LAL compared
with their personal experience with liposuction (12). Both Sun
et al. and Kim and Geronemus reported no serious adverse
effects following case studies of LAL in 35 and 29 patients,
respectively (18,24). Kim and Geronemus used MRI to evalu-
ate the volume of fat reduction in 10 patients treated with
LAL, using the pulsed Nd:YAG laser and found 17% fat vol-
ume reduction. In addition, patients noted a 37% improve-
ment at 3 months, quick recovery times and visible skin
retraction (18). Smaller baseline volume areas, such as the
