Laser surgery
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Laser surgery | |
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MeSH | D053685 |
Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue.[1]
Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and potassium titanyl phosphate, among others.
Soft-tissue laser surgery is used in a variety of applications in humans (
Effects
- 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 oesophageal and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
- Photoablative effect: Used in eye surgeries like band keratoplasty, and endartectomy of peripheral blood vessels.
- Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophageal varices
- Photomechanical effect: used in intraluminal lithotripsy
Equipment
Surgical laser systems, sometimes called "laser scalpels", are differentiated not only by the wavelength, but also by the light delivery system: flexible fiber or articulated arm, as well as by other factors.[8]
CO2 lasers were the dominant soft-tissue surgical lasers as of 2010.[9]
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 bypasses the skin surface. The principle of laser surgery for dermatologic problems 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 the removal of unwanted tissue by laser surgery.
Lasers are also used for laser-assisted
Eye surgery
Various types of laser surgery are used to treat
Lasers are also used to treat non-refractive conditions, such as phototherapeutic keratectomy (PTK) in which opacities and surface irregularities are removed from the cornea and laser coagulation in which a laser is used to cauterize blood vessels in the eye, to treat various conditions. Lasers can be used to repair tears in the retina.
Endovascular surgery
Laser
Foot and ankle surgery
Lasers are used to treat several disorders in
A
Gastro-intestinal tract
- photoablationis done.
- Coagulation of colon.
- 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.
- Palliative laser therapy is given in advanced oesophageal cancers with obstruction of lumen. Recanalisationof the lumen is done which allows the patient to resume a soft diet and maintain hydration.
- Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
- Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
- Laser-assisted liver carbon dioxideand Nd:YAG lasers.
- The ablation of liver tumors can be achieved by selective photovaporization of the tumor.
- Endoscopic laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.
Oral and dental surgery
The CO2 laser is used in oral and
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.[20][21]
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.[22] Evidence-based data surrounding the use of lasers in spine surgery is limited and its safety and efficacy were poorly understood as of 2017.[23][24]
Thoracic surgery
In
Other advantages of laser surgery compared to conventional methods are that it leads to an improved postoperative lung function and that it gives the additional possibility to histologically analyze the removed material which would otherwise be destroyed through radiation or heat.
Hard tissues
Lasers are used to cut or ablate bones and teeth in dentistry.[29]
Other surgery
The CO2 laser is also used in gynecology, genitourinary, general surgery, otorhinolaryngology, orthopedic, and neurosurgery.
References
- ^ Shiel WC. "Medical Definition of Laser surgery". MedicineNet. Retrieved 10 May 2020.[dead link]
- PMID 28509563.
- ISBN 978-0-470-34412-5.
- ISBN 9780323444422.
- ^ Cuscheri; et al. "Essential Surgical Practice". Basic surgical training (4 ed.). pp. 62–65.
- ^ Schwesinger, WH; Hunter, JG (1992). Laser in General Surgery. Surgical Clinics of North America.
- ^ Morris, Peter J; Wood, William C. Oxford Textbook of Surgery. Vol. 2.
- ^ Rosenlicht, J; Vitruk, P (2015). "Ablation and sulcular debridement utilizing the CO2 laser for denture-induced gingival hyperplasia". Implant Practice US. 8 (2): 35–38.
- ISBN 978-0323079891.
- ^ 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.
- .
- S2CID 32295300.
- ^ "ReLEx SMILE Surgery & Procedures in Toronto". Clearview Vision Institute. Retrieved 2020-05-06.
- ^ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. (ed.). Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72.
- ^ 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.
- ^ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. (ed.). Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72.
- ^ 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. (ed.). Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 109–110.
- PMID 26355439.
- ^ 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.
- PMID 8153804.
- S2CID 23392627.
- PMID 24967347.
- ^ Stern, Jack (October 2009). "Lasers in Spine Surgery: A Review" (PDF). www.Spine.org.
- ^ "Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)". providers.bcidaho.com. Retrieved 2017-06-21.
- ^ Rolle A, Thetter O, Häussinger K. et al. Einsatz des Nd:YAG-Lasers in der Thoraxchirurgie. Herz Gefäß Thorax Chir 1989; 3:85-91
- ^ Inderbitzi R, Rolle A. Palliative surgery for primary and secondary thoracic malignancies. Ther Umsch 2001 Jul;58(7) 435-41
- ^ Rolle A, Pereszlenyi A, Koch R et al. Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm :YAG laser. J Thorac Cardiovasc Surg 2006; 131(6): 1236-1242
- ^ Mineo TC, Cristino B, Ambrogi V et al. Usefulness of the Nd: YAG laser in parenchyma-sparing resection of pulmonary nodular lesions. Tumori 1994; 80(5):365-369
- ISBN 978-0-86715-476-4.