Laser surgery

Laser surgery
MeSH D053685

Laser surgery is surgery that uses a laser (instead of a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content. Laser resurfacing is a technique in which covalent bonds of a material are dissolved by a laser, a technique invented by aesthetic plastic surgeon Thomas L Roberts, III using CO2 lasers in the 1990s.[1][2] The CO2 (carbon dioxide) laser remains the gold standard for the soft tissue surgery because of the ease of simultaneous photo-thermal ablation and coagulation (and small blood capillary hemostasis).[3]

Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photorefractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of tissue.[4][5][6] Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and Potassium titanyl phosphate.

Effects

  1. Photochemical effect: clinically referred to as photodynamic therapy. Photosensitizer (photophrin II) is administered which is taken up by the tumor tissue and later irradiated by laser light resulting in highly toxic substances with resultant necrosis of the tumor. Photodynamic therapy is used in palliation of oesophagial and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
  2. Photoablative effect: Used in eye surgeries like band keratoplast, and endartectomy of peripheral blood vessels.
  3. Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophagial varices
  4. Photomechanical effect: used in intraluminal lithotripsy

Applications

Dermatology and plastic surgery

A range of lasers such as erbium, dye, Q switch lasers and CO2 are used to treat various skin conditions including scars, vascular and pigmented lesions, and for photorejuvenation. The laser surgery for dermatology often bypass the skin surface. The principle of laser surgery for dermatologic problem is based on SPTL(selective photothermolysis). The laser beam penetrates the skin until it encounters chromophore which absorbs the laser beam. After absorption of the laser beam, heat is generated to induce coagulation, necrosis of the targeted tissue, this results in removal of unwanted tissue by laser surgery.

Eye surgery

Various types of laser surgery are used to treat refractive error:

Lasers are also used to treat non-refractive conditions, such as:

Endovascular surgery

Laser endarterectomy is a technique in which an entire atheromatous plaque in the artery is excised. Laser recanalization of blocked arteries. other applications include laser assisted angioplasties and laser assisted vascular anastomosis.

Foot and ankle surgery

Lasers are used to treat several disorders in foot and ankle surgery. They are used to remove benign and malignant tumors,[7] treat bunions,[8] debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and keloids, and the removal of hypertrophic scars and tattoos.[9]

A carbon dioxide laser (CO2) is used in surgery to treat onychocryptosis (ingrown nails), onychauxis (club nails), onychogryposis (rams horn nail), and onychomycosis (fungus nail).[10]

Gastro-intestinal tract

  1. Peritoneum-Laser is used for adhesiolysis.
  2. Peptic ulcer disease and oesophageal varices - Laser photoablation is done.
  3. Coagulation of vascular malformations of stomach, duodenum and colon.
  4. Lasers can be effectively used to treat early gastric cancers provided they are less than 4 cm and without lymph node involvement. Lasers are also used in treating oral submucous fibrosis.
  5. Palliative laser therapy is given in advanced oesophageal cancers with obstruction of lumen. Recanalisation of the lumen is done which allows the patient to resume soft diet and maintain hydration.
  6. Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
  7. Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
  8. Laser-assisted liver resections have been done using carbon dioxide and Nd:YAG lasers.
  9. Ablation of liver tumors can be achieved by selective photovaporization of the tumor.
  10. Endoscopic laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.

Oral and dental surgery

The CO2 laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies.[11][12] The CO2 10,600 nm wavelength is safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. The laser may also be effective in treating peri-implantitis.[13]

Spine surgery

Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within discectomy to treat lumbar disc disease under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain.[14][15]

Since that time, laser spine surgery has become one of the most marketed forms of minimally invasive spine surgery, despite the fact that it has never been studied in a controlled clinical trial to determine its effectiveness apart from disc decompression.[16][17] Evidence-based data surrounding the use of lasers in spine surgery is limited primarily due to the presence of a number of challenging factors including patient selection, operative indications in the type of laser used in the procedure.[18] As a result, the official Blue Cross of Idaho position on laser disc surgery concluded:[19]

"Evidence on decompression of the intervertebral disc using laser energy consists of observational studies. Given the variable natural history of back pain and the possibility of placebo effects with this treatment, observational studies are insufficient to permit conclusions concerning the effect of this technology on health outcomes."

Other surgery

The CO2 laser is also used in gynecology, genitourinary, general and thoracic surgery, otorhinolaryngology, orthopedic, and neurosurgery.[20]

References

  1. ↑ Roberts, Thomas L III. The emerging role of the CO2 laser in aesthetic plastic surgery. Presented at the XIII Congress of the International Society for Aesthetic Plastic Surgery, New York, NY, Sept. 28-Oct. 1, 1995.
  2. ↑ Roberts, Thomas L III; Lettieri, John T; Ellis, Laura B. (1996). "CO2 Laser Resurfacing: Recognizing and Minimizing Complications". Aesthetic Surgery Journal. American Society for Aesthetic Plastic Surgery: 142–148. doi:10.1016/S1090-820X(96)70038-9.
  3. ↑ "Laser Tissue Interaction". LightScalpel.
  4. ↑ Cuscheri; et al. "Essential Surgical Practice". Basic surgical training. (4 ed.). pp. 62–65.
  5. ↑ Schwesinger, WH; Hunter, JG (1992). Laser in General Surgery. Surgical Clinics of North America.
  6. ↑ Morris, Peter J; Wood, William C. Oxford Textbook of Surgery. 2.
  7. ↑ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72.
  8. ↑ Wynn D.P.M., Michael H. (October 1986). "Soft-Tissue Bunion Repair with a CO2 Surgical Laser". The Journal of Current Podiatric Medicine. 35 (10): 27–28.
  9. ↑ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72.
  10. ↑ Gorman, Jack B. (February 1989). "Clinical Application of the Carbon Dioxide Laser to Podiatric Nail Pathologies: A Definitive Review of the Literature". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 109–110.
  11. ↑ Kaplan, Martin; Vitruk, Peter (2015). "Soft tissue 10,600 nm CO2 laser orthodontic procedures". Orthodontic Practice US. 6 (6): 59–64.
  12. ↑ Levine, Robert; Vitruk, Peter (2015). "Laser-Assisted Operculectomy". Compend Contin Educ Dent. 36 (8): 561–567.
  13. ↑ Linden, Eric; Vitruk, Peter (2015). "SuperPulse 10.6 µm CO2 laser-assisted, closed flap treatment of peri-implantitis". Implant Practice US. 8 (4): 30–34.
  14. ↑ Quigley, M. R.; Maroon, J. C. (1994-01-01). "Laser discectomy: a review". Spine. 19 (1): 53–56. ISSN 0362-2436. PMID 8153804.
  15. ↑ Ascher, P. W.; Heppner, F. (1984). "CO2-Laser in neurosurgery". Neurosurgical Review. 7 (2-3): 123–133. ISSN 0344-5607. PMID 6436735.
  16. ↑ Snyder, Laura A.; O'Toole, John; Eichholz, Kurt M.; Perez-Cruet, Mick J.; Fessler, Richard (2014). "The Technological Development of Minimally Invasive Spine Surgery". BioMed Research International. 2014: 1–9. ISSN 2314-6133. PMC 4055392 Freely accessible. PMID 24967347. doi:10.1155/2014/293582.
  17. ↑ Lim, MD, Jae Y. "The Truth About Laser Spine Surgery". Atlantic Brain & Spine.
  18. ↑ Stern, MD, PhD, FACS, Jack (October 2009). "Lasers in Spine Surgery: A Review" (PDF). www.Spine.org.
  19. ↑ "Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)". providers.bcidaho.com. Retrieved 2017-06-21.
  20. ↑ "Laser Surgery". LightScalpel.
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