Search

Abstract Biological soft tissues manipulation, including conventional (mechanical) and nonconventional (laser, waterjet and ultrasonic) processes, is critically required in most surgical innervations. However, the soft tissues, with their nature of anisotropic and viscoelastic mechanical properties, and high biological and heat sensitivities, are difficult to manipulated. Moreover, the mechanical and thermal induced damage on the surface and surrounding tissue during the surgery can impair the proliferative phase of healing. Thus, understanding the manipulation mechanism and the resulted surface damage is of importance to the community. In recent years, more and more scholars carried out researches on soft biological tissue cutting in order to improve the cutting performance of surgical instruments and reduce the surgery induced tissue damage. However, there is a lack of compressive review that focused on the recent advances in soft biological tissue manipulating technologies. Hence, this review paper attempts to provide an informative literature survey of the state-of-the-art of soft tissue manipulation processes in surgery. This is achieved by exploring and recollecting the different soft tissue manipulation techniques currently used, including mechanical, laser, waterjet and ultrasonic cutting and advanced anastomosis and reconstruction processes, with highlighting their governing removal mechanisms as well as the surface and subsurface damages.

Abstract Bone cutting is of importance in orthopaedic surgery but is also challenging due to its nature of brittleness—where severe mechanical and thermal damages can be introduced easily in conventional machining. Laser machining is a new technology that can allow for complex cut geometries whilst minimising surface defects i.e., smearing, which occur in mechanical methods. However, comparative studies on the influence of lasers with different pulse characteristics on necrotic damage and surface integrity have not been reported yet. This paper for the first time investigates the effects of laser type on the necrotic damage and surface integrity in fresh bovine cortical bone after ex-situ laser machining. Three lasers of different pulse widths, i.e., picosecond, nanosecond and continuous wave lasers have been investigated with different feed speeds tested to study the machining efficiency. The cutting temperature, and geometrical outputs have been measured to investigate the thermal influence on the cooling behaviour of the bone samples while high-speed imaging was used to compare the material removal mechanisms between a pulsed and continuous wave laser. Furthermore, an in-depth histological analysis of the subsurface has revealed that the nanosecond laser caused the largest necrotic depth, owing to the high pulse frequency limiting the dissipation of heat. It has also been observed that surface cracks positioned perpendicular to the trench direction were produced after machining by the picosecond laser, indicative of the photomechanical effect induced by plasma explosions. Therefore, the choice of laser type (i.e., in terms of its pulse width and frequency) needs to be critically considered for appropriate application during laser osteotomy with minimum damage and improved healing.