Noninvasive laser coagulation of the human vas deferens: Optical and thermal simulations

Background and Objectives Successful noninvasive laser coagulation of the canine vas deferens, in vivo, has been previously reported. However, there is a significant difference between the optical properties of canine and human skin. In this study, Monte Carlo (MC) simulations of light transport through tissue and heat transfer simulations are performed to determine the feasibility of noninvasive laser vasectomy in humans. Materials and Methods A laser wavelength of 1,064 nm was chosen for deep optical penetration in tissue. MC simulations determined the spatial distribution of absorbed photons inside the tissue layers (epidermis, dermis, and vas). The results were convolved with a 3-mm-diameter laser beam, and then used as the spatial heat source for the heat transfer model. A laser pulse duration of 500 milliseconds, pulse rate of 1 Hz, and cryogen spray cooling were incident on the tissue for 60 seconds. Average laser power (5-9 W), cryogen pulse duration (60-100 milliseconds), cryogen cooling rate (0.5-1.0 Hz), and increase in optical transmission due to optical clearing (0-50%) were studied. Results After application of an optical clearing agent (OCA) to increase skin transmission by 50%, an average laser power of 6 W, cryogen pulse duration of 60 milliseconds, and cryogen cooling rate of 1 Hz resulted in vas temperatures of approximately 58°C, sufficient for thermal coagulation, while 1 mm of the skin surface (epidermis and dermis) remained at a safe temperature of approximately 45°C. Conclusions MC and heat transfer simulations indicate that it is possible to noninvasively thermally coagulate the human vas deferens without adverse effects (e.g., scrotal skin burns), if an OCA is applied to the skin prior to the procedure.