Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical Surgery2070-478X2409-143XVoronezh State Medical University113910.18499/2070-478X-2018-11-2-119-125UnknownDetermination of the effective mode of laser radiation for coagulation of the wall of the Baker cyst in the ex-vivo experiment.ZhilyakovAndrey V<p>candidate of medical Sciences, limited liability company "New technologies for outpatient medicine"</p>doctor-zhilyakov@rambler.ruhttps://orcid.org/0000-0003-1261-3712ChernyadievSergey Aleksandrovich<p>M. D., Professor of the Ural state medical University<br /><br /></p>chsa-surg@mail.ruhttps://orcid.org/0000-0003-4207-1862AretinskyAlexander Vitalievich<p>doctor of the radiologist / radiographer, limited liability company “PET - technology”</p>a.aretinskiy@pet-net.ruhttps://orcid.org/0000-0001-7310-8782SivkovaNadezhda Ivanovna<p>candidate of sociological sciences, associate Professor, Ural Federal University named after first President of Russia B. N. Yeltsin</p>Letica@mail.ruhttps://orcid.org/0000-0002-6331-0124GorbatovVladimir Ivanovich<p>candidate of physical and mathematical sciences, associate Professor of Ural state mining University</p>gorbatov@ursmu.ruhttps://orcid.org/0000-0001-8066-0217MedvedevaSvetlana Jur'evna<p>candidate of medical Sciences, leading researcher of the laboratory of morphology and biochemistry of the Institute of immunology and physiology Ural branch of the Russian Academy of Sciences</p>medvedeva-ran@yandex.ruhttps://orcid.org/0000-0002-1410-0139KorobovaNatalia Yuryevna<p>assistant Professor, Ural state medical University</p>olvin.phlebolog@mail.ruhttps://orcid.org/0000-0002-8523-912XChernookovAlexander Ivanovich<p>M.D., Professor, JSC "Center of Phlebology"</p>chsa-surg@mail.ruGeneral Director of the Limited Liability Company "New Technologies for Outpatient Medicine"Ural State Medical UniversityThe federal network of Nuclear Medicine centers - PET – TechnologyUral Federal University named after the first President of Russia B.N. YeltsinUral State Mining UniversityInstitute of Immunology and Physiology of the Ural Branch of the Russian Academy of SciencesCenter of Phlebology300620181121191251812201721012018Copyright © , Zhilyakov A.V., Chernyadiev S.A., Aretinsky A.V., Sivkova N.I., Gorbatov V.I., Medvedeva S.J., Korobova N.Y., Chernookov A.I.<p>Relevance. The Baker's cyst is the most numerous group of benign neoplasms of the popliteal region. The anatomical feature of the location, the vagueness of the etiology and pathogenesis leads to the lack of a single point of view on the tactics of treating popliteal cysts. In modern medical technologies, the method of local laser hyperthermia is often used, when the denaturing of collagen forming the basis of a tissue or an organ is based on surgical treatment. Since this technique does not have direct thermal control over the course of manipulation, it becomes necessary to strictly dosage controlled photocoagulation.</p>
<p>Objectives of the study: to determine the optimal energy and time parameters of direct contact laser action on the wall of the Baker cyst in the simulation of its exo-vivo photocoagulation.</p>
<p>Materials and methods of research. In the experiment we used a wall sample of Baker's cyst, obtained as a result of open extirpation of the cyst. The material was divided into 5 roughly equal in size and mass fragments. The first of them, without any physical effects, was immediately placed in a 10% formalin solution. For all other parts of the preparation, laser irradiation was carried out in a stationary manner with a surface contact of the optical fiber with the synovial layer of the samples. The effect on the fragment was carried out in a constant mode of the light flux with a wavelength of 1.47 m.</p>
<p>Results. The macroscopic and microscopic transformations that occur in the tissues of the wall of the Baker cyst were studied, with an output power of 5 and 10 W. Two series of experiments were conducted lasting 5 and 10 seconds.</p>
<p>On the surface of the synovial membrane of the wall of Baker's cyst, the effect in the form of point carbonation was observed in all samples subjected to laser treatment. When a microscopic study of a drug not exposed to laser radiation, the synovial membrane was only loosened. In the fragment subjected to the contact action of 10 W laser radiation for 10 seconds, the focus of necrosis of the synovium and surface layers of collagen structures without a perifocal cell reaction is histologically determined. In all other samples, after laser photocoagulation, a focal destruction of the synovial membrane with a pronounced interstitial edema was determined in the histological study. Focal fragmentation of the surface fibers was detected near the loose collagen layers.</p>
<p>Conclusions. The effect of high-energy laser radiation of 1.47 m on the wall of the Baker cyst in all series of experiments did not lead to its total coagulation necrosis even in the direct irradiation zone. Considering the duration of the cyst of the energy exposure of the irradiation sufficient for the destruction of the wall, and also the small area of exposure of the laser irradiation to the face lightguide, it is evident that a considerable amount of time will be required for complete coagulation of the formation.</p>Laser coagulation, surgical radiation regimes, Baker's cyst, process modelingЛазерная коагуляцияхирургические режимы излучениякиста Бейкерамоделирование процесса[1. Liao S. T., Chiou C. S., Chang C. C. Pathology associated to the Baker's cysts: a musculoskeletal ultrasound study //Clinical rheumatology. – 2010. – Т. 29. – №. 9. – С. 1043-1047.][2. Herman A. M., Marzo J. M. Popliteal cysts: a current review //Orthopedics. – 2014. – Т. 37. – №. 8. – С. e678-e684.][3. Morozov S.P., Ternovoj S.K., Gorodnichenko A.I., Arcybasheva M.V., Filisteev P.A.. Magnetic resonance imaging in the diagnosis of injuries and diseases of the knee joint //Kremlevska jamedicina. Klinicheskij vestnik. – 2014. – №. 2. – S. 58-62.][4. Korobova N.Ju. Lazernaja obliteracija kist Bejkera: dis. ... kand. med.nauk. Ekaterinburg, 2015.138 s.][5. Ignat'eva N. Ju. Thermal stability of collagen in connective tissues: dissertacija ... doktora himicheskih nauk : 02.00.04 / Ignat'eva Natalija Jur'evna; Mesto zashhity: Mosk. gos. un-tim. M.V. Lomonosova.-Moskva, 2011.- 301 s..][6. Avtandilov G.G., red. Medicinskaja morfometrija: Ruk-vo dlja vrachej. M., 1990.384 s.Romejs B. Microscopic technology / Per. s nem.– M.,1953.– 720 s.][7. Romejs B. Mikroskopicheskaja tehnika / Per. s nem.– M.,1953.– 720 s.][8. Smith M.K, Lesniak B., Baraga M.G, Kaplan L., Jose J. Treatment of popliteal (baker) cysts with ultrasound-guided aspiration, fenestration, and injection: long-term follow-up //Sports health. - 2015. - T. 7. - №. 5. - C. 409-414.][9. Kim J.S, Lim S.H, Hong B.Y, Park S.Y. Ruptured popliteal cyst diagnosed by ultrasound before evaluation for deep vein thrombosis //Annals of rehabilitation medicine. - 2014. - T. 38. - №. 6. - C. 843-846.][10. Dirschl D.R., Lachiewicz P.F. Dissecting popliteal cyst as the presenting symptom of a malfuntioning total knee arthroplasty: Report of four cases //The Journal of arthroplasty. - 1992. - T. 7. - №. 1. - C. 37-41][11. Hommel H., Perka C., Kopf S. The fate of Baker's cyst after total knee arthroplasty // Bone Joint J. - 2016. - T. 98. - №. 9. - С. 1185- 1188][12. Bevers K., Vriezekolk J.E., Bijlsma J.W., van den Ende, C.H., den Broeder A.A. Ultrasonographic predictors for clinical and radiological progression in knee osteoarthritis after 2 years of follow-up //Rheumatology. - 2015. - T. 54. - №. 11. -C. 2000-2003.][13. Shahno E. A. The physical basis of the use of lasers in medicine //S-Pb, Uchebnoeposobie -2012. 266p/][14. Sokolov A.L., Ljadov K.V., Lucenko M.M. Laser obliteration of veins for practical doctors. — M.: Medpraktika-M, 2011. — 136 s.][15. Shevchenko Ju.L., StojkoJu.M., Mazajshvili K.V. Laser surgery of varicose veins. — M.: Borges, 2010. — 195 s.][16. Mazajshvili K.V., Stojko Ju.M., Hlevtova T.V., Kutidze I.A., Morenko D.N. Perforation of the venous wall as the leading cause of pain syndrome after endovenous laser obliteration //Angiologija i sosudistaja hirurgija. - 2011. - T. 17 - №. 3 -S. 79-83.][17. Reszko A.E., Magro C.M., Diktaban T, Sadick N.S. Histological comparison of 1064 nm Nd: YAG and 1320 nm Nd: YAG laser lipolysis using an ex vivo model //Journal of drugs in dermatology: JDD. - 2009. - T. 8. - №. 4. - C. 377-382.]