THE USE OF A DIODE LASER IN THE TREATMENT OF HEMORRHOIDAL DISEASE

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1 International Journal of Civil Engineering and Technology (IJCIET) Volume 9, Issue 11, November 2018, pp , Article ID: IJCIET_09_11_206 Available online at ISSN Print: and ISSN Online: IAEME Publication Scopus Indexed THE USE OF A DIODE LASER IN THE TREATMENT OF HEMORRHOIDAL DISEASE N. K. Zhizhin, D. N. Panchenkov Research Centre of the Federal Medical and Biological Agency of Russia, Moscow, Russia V. V. Kharlamov, S. A. Nikitin, A. Yu. Krylova, S. V. Titov The Russian State Scientific Center for Robotics and Technical Cybernetics, Saint Petersburg, Russia ABSTRACT The article presents the information on the application of a diode laser in the treatment of the 2nd and 3rd degree combined hemorrhoids, the use of innovative radial light guides, which allows minimizing damage to the rectal mucosa. Key words: diode laser, hemorrhoids, light guide Cite this Article: N. K. Zhizhin, D. N. Panchenkov, V. V. Kharlamov, S. A. Nikitin, A. Yu. Krylova, S. V. Titov, The Use of a Diode Laser in the Treatment of Hemorrhoidal Disease, International Journal of Civil Engineering and Technology (IJCIET) 9(11), 2018, pp INTRODUCTION Hemorrhoids is one of the most common human diseases for more than four thousand years. Suffice it to say that both hemorrhoids and their complications cause more than 40% of appeals to a surgeon or proctologist [1]. In Russia, hemorrhoidectomy remains the main method for treating hemorrhoids and is done in 75-79% of patients admitted to the inpatient department [2]. In other countries, the number of surgical treatment for this disease does not exceed 18-20% of all patients revealed [3]. The use of laser in proctology is unparalleled, since this type of physical effect allows intervention with minimal rectal mucosal damage. Less traumatic treatment of hemorrhoids applying a laser is innovative, and the use of radial light guides will allow the development of minimally invasive proctology. The purpose of this paper is to evaluate the use of a diode laser with radial and end light guides in the treatment of hemorrhoidal disease. The objectives of the work are: - refinement of methods of using radial and end light guides for the treatment of hemorrhoidal disease; - evaluation of the immediate results of the treatment of patients in the near-term postoperative period editor@iaeme.com

2 The Use of a Diode Laser in the Treatment of Hemorrhoidal Disease 2. MATERIALS AND METHODS Sixty patients were operated on at the Federal Scientific Clinical Center for Minimally Invasive Methods of Treatment, the Federal Biomedical Agency (FMBA) of Russia, Moscow; 40 of them are male and 20 female, the average age of the operated is 44 ± 3.7, all patients are of working age. The main symptom of hemorrhoidal disease was bleeding and pain. All patients underwent rectoscopy and colonoscopy before the operation for the verification of the neoplastic lesions of the colon and rectum. Concomitant diseases of the anorectal zone in patients were not observed. A diode laser with wavelength of 1560 nm was applied; it was made in St. Petersburg, it has two types of light guides: end and radial. Epidural anesthesia was performed in all patients. 3. FINDINGS The use of laser techniques in proctology is exceptional, since this type of physical impact allows minimizing damage to the rectal mucosa. When working with the device in a test mode, it was noted that the device is easy to use (PLUG & PLAY principle is applied), compact, convenient for transportation and use in various medical rooms during the working day. The touch screen in Russian allows quick usage of several operating modes during surgical interventions, sometimes even in one patient. For the destruction of hemorrhoidal nodes in 30 patients, a wavelength of 1.56 μm and an end light guide were used. Herewith, the effect of denaturation of tissue proteins is observed, the knot leg was stitched with 3-0 Vicril thread on a round needle, with the aim of additional hemostasis and lifting the mucous membrane. When using radial light guides, percutaneous administration into the submucosal layer was performed and the hemorrhoids were coagulated radially, the effect of proteins denaturation in tissue was not observed, the work was carried out at a laser power of no more than 8 W. In case of mucosal prolapse, it was raised with 3-0 Vicyril thread on a round needle. In the postoperative period, the pain syndrome was minimal and disappeared on the 2nd day after the surgery, and the average duration of invalidity was days. Pain syndrome analysis was carried out by a Numeric Pain Rating Scale (NRS), pain syndrome amounted to 3-4 points when using end light guides, 1-2 points when applying radial light guides, after 3 days there was no pain syndrome. Epideural anesthesia was performed in 60 cases for all patients. This type of anesthesia involves the anesthetic administration in the immediate vicinity of the spinal cord, so they are united by the notion of central anesthesia. In order to prevent the development of arterial hypotension, patients are given a volemic (infusion) load with crystalloid solutions, if necessary with colloid solutions. This results in a growth in preload and, thus, an increase in venous return and normalization of cardiac output. Dynamic monitoring of blood pressure, pulse, respiratory rate, pulse oximetry is carried out at the initial examination of the patient, during the preparation and conduct of anesthesia and in the postoperative period. 4. DISCUSSION OF THE RESULTS AND CONCLUSIONS The use of laser in proctology allows for the efficient treatment of pathologies of the distal rectum and perianal area. One of the most effective methods of using lasers in proctology is minimally invasive laser coagulation of hemorrhoidal vessels. Blood coagulation is a highly complicated biological phenomenon leading to the formation of a blood clot. The essence of the process of coagulation in blood vessels is the ability to heat the blood to a temperature of about degrees Celsius, which results in deoxidation of oxygen-saturated oxyhemoglobin and its transition to the so-called methemoglobin editor@iaeme.com

3 N. K. Zhizhin, D. N. Panchenkov, V. V. Kharlamov, S. A. Nikitin, A. Yu. Krylova, S. V. Titov Physical management methods applied to coagulate blood vessels include the use of ultrasound, microwave and laser radiation. So one of these devices using mechanical compression, ultrasound diagnostics and ultrasound coagulation is the device proposed in the work by Jimin Zhang et al. [4]. The main difference in the use of laser radiation from ultrasonic heating or non-monochromatic photocoagulation is the possibility of providing a selective effect on tissues with the correct choice of the radiation wavelength. This means that the use of laser radiation to solve the issue of coagulation of blood in a vessel leads to a relatively small heating of the surrounding tissues. For effective blood coagulation, hemoglobin must effectively absorb radiation, while the absorption of radiation by the tissues surrounding the vessel must be less to ensure the principle of selection. Further, in order to solve the laser coagulation problem, it is advisable to use a pulse-periodic exposure mode, which will increase the efficiency of blood coagulation and ensure the safety of surrounding tissues due to the smaller heating zone. It is also important to note the minimally invasive and convenient methods of delivering laser radiation to the area of impact. The laser radiation is delivered to the affected area in the thickness of the tissues along a flexible optic fiber of small diameter, and the coagulation process itself can be carried out both endovasally and through tissue. Thus, laser coagulation of blood laser can be spectrally selective, while providing reduced heating of the tissues surrounding the vessels. The main advantages of using lasers for the treatment of hemorrhoids are: Tissue volume reduction in hemorrhoids; Restoration of the natural anatomical structure; Reducing risk of disease recurrence; Minimizing thermal tissue damage; Minor invasiveness; High impact precision; Minimizing side effects and complications; Reduced operation time; Reduced patient rehabilitation time [5]. Diode lasers are widely used in medical technology. Being highly reliable, with output efficiency, simplicity and low cost, but at the same time with sufficient quality of the output parameters of laser radiation, diode lasers have become extremely competitive in all areas of medicine. Until recently, the factor limiting the use of diode lasers was the large angular divergence of the radiation, determined by the specific geometry of the laser emitting zone. In lasers of a new generation, this problem has been solved with the use of high-quality microoptics and the use of technology to introduce radiation from a diode array into an optical fiber. The variety of design solutions and a wide list of materials used in the production allows choosing such a model of a diode laser that will provide optimal conditions (wavelength, radiation power, pulse repetition rate) for the effect of blood vessel coagulation. Most commonly used in medical practice are diode lasers with wavelengths of nm, 652 nm, 668 nm, 689 nm, 730 nm, 810 nm, 915 nm, 940 nm, 980 nm, as well as 1064 nm, 1210 nm, nm, nm and nm in the longer wavelength range [6]. To improve the efficiency of coagulation of blood vessels, the technique of two-wave laser effect can be implemented. Due to the differences in the optical properties of biological editor@iaeme.com

4 The Use of a Diode Laser in the Treatment of Hemorrhoidal Disease tissues at different wavelengths, each of which has its own biological tissue absorption depth (Figure 1), it is possible to integrate radiation from different diode lasers with different radiation wavelength to optimize radiation modes, which will ensure the necessary properties of laser exposure [7]. Figure 1 Absorption by biological tissues of radiation with different wavelengths Thus, to solve the problem of increasing the efficiency of laser coagulation, the combined laser radiation of low energy density at micron wavelength (highly absorbed in hemoglobin in blood) can be used for initiating the coagulation process together with more powerful simultaneous radiation at 1.56 μm wavelength (corresponding to the water absorption peak). The use of a diode laser in the treatment for hemorrhoids is promising, it requires an assessment of the long-term results of treatment, and cytomorphological studies in the anorectal tissue. ACKNOWLEDGMENTS The article was prepared with the financial support of the Ministry of Education and Science in the course of work under the Agreement of No RFMEFI57816X0207 on providing subsidies for the implementation of the federal target program Research and inventions in priority areas for the development of the scientific and technical complex in Russia in REFERENCES [1] Vorobiev, G. I. Basics of Coloproctology. Rostov-on-Don: Phoenix Publishing House, 2001, pp [2] Zhizhin, N. K., Sarkisyan, Yu. G., Potapova, Yu. V. and Ivanov, Yu. V. The Use of a Diode Laser in the Treatment of Hemorrhoidal Disease. Clinical Practice, 4, 2016, pp [3] Rivkin, V. L., Bronstein, A. S. and Fayn, S. N. Guide to Coloproctology. Moscow: Medpraktika Publishing House, 2001, pp editor@iaeme.com

5 N. K. Zhizhin, D. N. Panchenkov, V. V. Kharlamov, S. A. Nikitin, A. Yu. Krylova, S. V. Titov [4] Zhang, J., Perozek, D., Kook, J., Caldwell, E., Emery, C., Pedersen, R. Systems and Methods for Performing Acoustic Hemostasis of Deep Bleeding Trauma in Limbs. Patent US 2007/ A1. [5] Jahanshani, A., Mashhadizadeh, E. and Sarmast, M. H. Diode Laser for Treatment of Symptomatic Hemorrhoid: A Short Term Clinical Result of a Mini Invasive Treatment, and One Year Follow Up. Polish Journal of Surgery, 84(7), 2012, pp [6] Nasim, H. and Jamil, Y. Diode Lasers: From Laboratory to Industry. Optics & Laser Technology, 56, 2014, pp [7] Tarkhov, N. S. and Davydova, E. A. Two-Wave Laser Surgical Apparatus. Bulletin of Tula State University. Engineering Sciences, 12, 2016, pp editor@iaeme.com