LASER APPLICATIONS IN SURGERY
Lasers were first developed in 1960 for industrial uses like the precise cutting of metals and plastics. During the next 20 years, laser design and engineering were advanced to produce systems with more carefully controlled output parameters – necessary for their growing role in medical care. Today, lasers have revolutionized patient care in dermatology, cosmetic surgery, ophthalmology, ENT, oncology and dentistry, to name just a few. In fact, laser therapy has become the gold standard of care for a wide range of medical therapies and cosmetic conditions.
In the sections below, more specific examples are given of the uses to which lasers have been put in the various medical disciplines. The links on the right give some video examples of the types of procedures possible with some of the more well-known surgical laser systems.
Various types of lasers are used to successfully treat numerous conditions of the urinary and genital systems. They include: urinary stones, cancers of the kidney lining, ureters and urinary bladder, obstructions due to narrowing of the uretero-pelvic junction, ureteral strictures, benign enlargement of the prostate (BPH), urethral strictures, benign condylomas (warts) of the penis and urethra, and superficial cancers of the penis. Most of these treatments may require general anesthesia and can be performed as outpatient procedures with little or no blood loss and excellent results.
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Head and Neck Surgery was one of the first areas in surgery where lasers found application and transformed clinical care. The carbon dioxide laser (CO2) remains the workhorse in the treatment of disorders of the upper aerodigestive tract in which non-contact, precise and hemostatic surgery is necessary. The role of the CO2 laser has expanded substantially in recent years and now is used to endoscopically remove advanced laryngeal and pharyngeal cancers, which previously required removal via a neck incision. Similarly, KTP: (Nd:YAG) and Ho:YAG lasers have been used to manage diseases in the nose, paranasal sinuses, larynx, and trachea. More recently, breathtaking advances in fiber laser technology and other non-conventional laser devices have lead to new applications in office-based laryngeal and upper airway surgery. Pulsed dye lasers are being more broadly adopted for treatment of a wide range of true vocal fold and laryngeal disorders. Lasers are used to treat ear disease and cranial base disorders as well. In otosclerosis, which is a fixation of the stapes footplate, “optical drilling” facilitates the precise removal of bone to improve hearing. Lasers are also used to reduce or eradicate vascular lesions and neoplasms in infants, children, and adults that obstruct the airway. As facial plastic surgeons, otolaryngologists also apply various laser wavelengths to resurface the face, reshape cartilage of the ear and nose, and manage vascular malformations. Currently, head and neck surgeons are at the forefront of using minimally invasive approaches such as imaged guided surgery, robotics and lasers to treat diseases within the head, neck, and upper airway.
Many surgical procedures can be performed using lasers. General surgeons use a variety of laser wavelengths and laser delivery systems to cut, coagulate, vaporize or remove tissue. The majority of "laser surgeries" actually use the laser device in place of other tools such as scalpels, electrosurgical units, cryosurgery probes or microwave devices to accomplish a standard procedure like mastectomy (i.e. breast surgery) or cholecystectomy (i.e. surgical removal of the gallbladder). Lasers allow the surgeon to accomplish more complex tasks, reduce blood loss, decrease postoperative discomfort, reduce the chance of wound infection, decrease the spread of some cancers, minimize the extent of surgery in selected circumstances and result in better wound healing, if they are used appropriately by a skilled and properly trained surgeon. They are useful in both open and laparoscopic procedures. Common surgical uses include breast surgery, removal of the gallbladder, hernia repair, bowel resection, hemorrhoidectomy, solid organ surgery, and treatment of pilonidal cyst.
Although various lasers have been used for the past 30 years in just about every aspect of neurosurgical practice, the current applications in the field of neurosurgery represent years of practical experience and therefore represent the consensus of the neurosurgical community as to the currently acceptable and appropriate utilization of lasers in the field. Microsurgical lasers are used for precision cutting for making incisions into the brain and spinal cord and producing discrete lesions in the brain and spinal cord for relief of pain. The carbon dioxide laser and the Nd:YAG are used for making incisions and the KTP:YAG, argon and other shorter wavelength lasers are rarely used now by a few Neurosurgeons for these applications. The use of the laser has particularly been beneficial for very narrow and deep approaches that are oftentimes required to access tumors in these locations. At a few centers, fiberoptically delivered lasers are being more frequently used for the vaporization and shrinkage of spinal discs to treat patients with herniated discs within the upper, mid and lower back through a minimally invasive surgical approach using the endoscopic guidance. Proper selection of patients for these procedures is essential and is best determined by neurosurgeons specializing in spinal disorders.
- Periorbital skin rejuvenation.
- Treatment of vascular and pigmented eyelid lesions.
- Reshape the cornea in vision correction to improve nearsightedness, farsightedness and astigmatism. Refractive surgical procedures include LASIK.
- Remove/reduce certain superficial defects such as band keratopathy in the cornea. The procedure is called phototherapeutic keratoplasty.
- Place a window in a membrane called the posterior capsule if it opacifies following cataract surgery. The capsule holds the intraocular lens implant in place. The procedure is called YAG capsulotomy.
- Create a hole in the peripheral iris to prevent or treat an acute attack of narrow angle glaucoma. The procedure is called laser peripheral iridotomy.
- Place spots in the meshwork ("drain" of the eye) to lower eye pressure in open angle glaucoma. The procedure is called laser trabeculoplasty.
- Place spots in the ciliary body (produces fluid in the eye) to lower eye pressure in severe glaucomas. The procedure is called diode laser cyclophotocoagulation.
- Place spots in the peripheral retina to treat proliferative diabetic retinal disease. The procedure is called panretinal photocoagulation.
- Place spots in the central retina for leakage in diabetic macular edema. The procedure is called focal retinal photocoagulation.
- Place spots in the peripheral retina for progressing retinopathy of prematurity. The procedure is called retinal photocoagulation.
- Treat certain types of wet age-related macular degeneration, a disease characterized by distorted central vision and damage to the central portion of the retina. One procedure is called focal retinal photocoagulation, and one procedure is called photodynamic therapy.
The Many Conditions Treated by Laser include: Fungal nails; Ingrown nails; Deformed nails; Matrixectomies; Granulomas; Porokeratosis; Pigmented villondular; Synovitis; Neurofibromatosis; Periungual Fibromas; Remodeling hypertrophic scars, keloids; Hemangiomas; Adjunct ulcer therapy (ulcer debridement); Plantar warts: Skin fissures; Tumors; Various types of cysts including foreign body cysts; Incision and excision of neuromas; The release of sub lesional hematomas.
- Enlarged blood vessels (telangiectasias) on the face & legs; red nose & red cheeks.
- Dilated vessels on the legs and deeper varicose veins.
- Wrinkles, fine lines, sagging and aging skin on the face, neck, chest, and other areas.
- Unwanted hair.
- Port wine stains, hemangiomas and other benign blood vessel lesions.
- Pigmented lesions such as freckles "sun spots", birthmarks, cafe' au lait macules.
- Benign skin growths.
- Stretchmarks.
- Scars.
- Traumatic and decorative tattoos.
- Acne, acne rosacea and acne scarring.
- Precancerous lesions and some types of skin cancer.
- Localized areas of fat such as the upper neck, abdomen, arms and other areas.
Dermatology, and certain areas of plastic surgery, are, of course, closely connected with the more aesthetic and cosmetic use of laser systems. For more information on these types of products, and other technologies in the same application area, go to www.lynton.co.uk
