Noncontact tissue ablation by Holmium: YSGG laser pulses in blood

To assess the feasibility of intra‐arterial tissue ablation by Holmium:YSGG laser pulses (2.1 μm) in a noncontact mode, the transmission of the laser pulses through saline and blood was measured. The temporal interaction between the 500 μs laser pulse and saline at the fiber tip was investigated with time‐resolved flash photography. The penetration depth in blood and saline depended on the fiber output energy. In blood at 37°C, the penetration depth varied from 1.2 to 2.1 mm for intensities of 3.1 to 12.4 J/mm² per pulse, respectively, whereas its theoretical value for water is 0.33 mm, which is based on the measured absorption coefficient of 3.0 ± 0.1/mm. The large penetration depth was due to the development of a transparent vapour cavity around the fiber tip. In saline, its maximum length was 4.7 mm. Its maximum width was 2.8 mm. The lifetime of the cavity was 450 μs. In blood, ablation of porcine aorta was feasible at a distance of 3 mm. Large fissures observed in adjacent tissue are likely to be caused by the expansion of the vapour cavity. We conclude that, due to a “Moses effect in the microsecond region,” Holmium: YSGG tissue ablation is possible through at least 2.7 mm of blood.