Laser medicine is the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy, [1] photorejuvenation, and laser surgery.
The word laser stands for "light amplification by stimulated emission of radiation". [2]
The laser was invented in 1960 by Theodore Maiman, [3] and its potential uses in medicine were subsequently explored. Lasers benefit from three interesting characteristics: directivity (multiple directional functions), impulse (possibility of operating in very short pulses), and monochromaticity. [4]
Several medical applications were found for this new instrument. In 1961, just one year after the laser's invention, Dr. Charles J. Campbell successfully used a ruby laser to destroy an angiomatous retinal tumor with a single pulse. [5] In 1963, Dr. Leon Goldman used the ruby laser to treat pigmented skin cells and reported on his findings. [6]
The argon-ionized laser (wavelength: 488–514 nm) has since become the preferred laser for the treatment of retinal detachment. The carbon dioxide laser was developed by Kumar Patel and others in the early 1960s and is now a common and versatile tool not only for medicinal purposes but also for welding and drilling, among other uses. [7]
The possibility of using optical fiber (over a short distance in the operating room) since 1970 has opened many laser applications, in particular endocavitary, thanks to the possibility of introducing the fiber into the channel of an endoscope.
During this time, the argon laser began to be used in gastroenterology and pneumology. Dr. Peter Kiefhaber was the first to "successfully perform endoscopic argon laser photocoagulation for gastrointestinal bleeding in humans". Kiefhaber is also considered a pioneer in using the Nd:YAG laser in medicine, also using it to control gastrointestinal bleeding. [8]
In 1976, Dr. Hofstetter employed lasers for the first time in urology. The late 1970s saw the rise of photodynamic therapy, thanks to laser dye. (Dougherty, 1972 [9] )
Since the early 1980s, applications have particularly developed, and lasers have become indispensable tools in ophthalmology, gastroenterology, and facial and aesthetic surgery.
In 1981, Goldman and Dr. Ellet Drake, along with others, founded the American Society for Laser Medicine and Surgery to mark the specialization of certain branches of medicine thanks to the laser. [10] In the same year, the Francophone Society of Medical Lasers (in French, Société Francophone des Lasers Médicaux) was founded for the same purpose and was first led by Maurice Bruhat. [11]
After the end of the 20th century, a number of centers dedicated to laser medicine opened, first in the OCDE, and then more generally since the beginning of the 21st century.
The Lindbergh Operation was a historic surgical operation between surgeons in New York (United States) and doctors and a patient in Strasbourg (France) in 2001. Among other things, they utilized lasers.
The laser presents multiple unique advantages that make it very popular among various practitioners.
The principal disadvantage is not medical but rather economic: its cost. Although its price has dropped significantly in developed countries since its inception, it remains more expensive than most other common technical means due to materials, the technicality of the equipment necessary for the operation of any laser therapy, and the fact that it requires only certain specific training.
For example, in France (as in other countries with a social security system), dental, endodontal or periodontal laser treatment is classified outside the nomenclature and not reimbursed by social security.
Lasers used in medicine include, in principle, any type of laser, but especially the following:
Examples of procedures, practices, devices, and specialties where lasers are utilized include the following:
Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation as well as to alleviate dermatologic diseases such as acne. IPL is increasingly used in optometry and ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction.
A dye laser is a laser that uses an organic dye as the lasing medium, usually as a liquid solution. Compared to gases and most solid state lasing media, a dye can usually be used for a much wider range of wavelengths, often spanning 50 to 100 nanometers or more. The wide bandwidth makes them particularly suitable for tunable lasers and pulsed lasers. The dye rhodamine 6G, for example, can be tuned from 635 nm (orangish-red) to 560 nm (greenish-yellow), and produce pulses as short as 16 femtoseconds. Moreover, the dye can be replaced by another type in order to generate an even broader range of wavelengths with the same laser, from the near-infrared to the near-ultraviolet, although this usually requires replacing other optical components in the laser as well, such as dielectric mirrors or pump lasers.
The term biophotonics denotes a combination of biology and photonics, with photonics being the science and technology of generation, manipulation, and detection of photons, quantum units of light. Photonics is related to electronics and photons. Photons play a central role in information technologies, such as fiber optics, the way electrons do in electronics.
Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) is a crystal that is used as a lasing medium for solid-state lasers. The dopant, neodymium in the +3 oxidation state, Nd(III), typically replaces a small fraction (1%) of the yttrium ions in the host crystal structure of the yttrium aluminum garnet (YAG), since the two ions are of similar size. It is the neodymium ion which provides the lasing activity in the crystal, in the same fashion as red chromium ion in ruby lasers.
Laser hair removal is the process of hair removal by means of exposure to pulses of laser light that destroy the hair follicle. It had been performed experimentally for about twenty years before becoming commercially available in 1995–1996. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998. Laser hair removal is widely practiced in clinics, and even in homes using devices designed and priced for consumer self-treatment. Many reviews of laser hair removal methods, safety, and efficacy have been published in the dermatology literature.
A gas laser is a laser in which an electric current is discharged through a gas to produce coherent light. The gas laser was the first continuous-light laser and the first laser to operate on the principle of converting electrical energy to a laser light output. The first gas laser, the Helium–neon laser (HeNe), was co-invented by Iranian engineer and scientist Ali Javan and American physicist William R. Bennett, Jr., in 1960. It produced a coherent light beam in the infrared region of the spectrum at 1.15 micrometres.
A tunable laser is a laser whose wavelength of operation can be altered in a controlled manner. While all laser gain media allow small shifts in output wavelength, only a few types of lasers allow continuous tuning over a significant wavelength range.
Atomic vapor laser isotope separation, or AVLIS, is a method by which specially tuned lasers are used to separate isotopes of uranium using selective ionization of hyperfine transitions. A similar technology, using molecules instead of atoms, is molecular laser isotope separation (MLIS).
A solid-state laser is a laser that uses a gain medium that is a solid, rather than a liquid as in dye lasers or a gas as in gas lasers. Semiconductor-based lasers are also in the solid state, but are generally considered as a separate class from solid-state lasers, called laser diodes.
Amplified spontaneous emission (ASE) or superluminescence is light, produced by spontaneous emission, that has been optically amplified by the process of stimulated emission in a gain medium. It is inherent in the field of random lasers.
Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel.
Photomedicine is an interdisciplinary branch of medicine that involves the study and application of light with respect to health and disease. Photomedicine may be related to the practice of various fields of medicine including dermatology, surgery, interventional radiology, optical diagnostics, cardiology, circadian rhythm sleep disorders and oncology.
Photorejuvenation is a skin treatment that uses lasers, intense pulsed light, or photodynamic therapy to treat skin conditions and remove effects of photoaging such as wrinkles, spots, and textures. The process induces controlled wounds to the skin. This prompts the skin to heal itself, by creating new cells. This process—to a certain extent—removes the signs of photoaging. The technique was invented by Thomas L Roberts, III using CO2 lasers in the 1990s. Observed complications have included scarring, hyperpigmentation, acne, and herpes.
Francisco Javier "Frank" Duarte is a laser physicist and author/editor of several books on tunable lasers.
Beam expanders are optical devices that take a collimated beam of light and expand its width.
A solid-state dye laser (SSDL) is a solid-state lasers in which the gain medium is a laser dye-doped organic matrix such as poly(methyl methacrylate) (PMMA), rather than a liquid solution of the dye. These lasers are also referred to as solid-state organic lasers and solid-state dye-doped polymer lasers.
Multiple-prism grating laser oscillators, or MPG laser oscillators, use multiple-prism beam expansion to illuminate a diffraction grating mounted either in Littrow configuration or grazing-incidence configuration. Originally, these narrow-linewidth tunable dispersive oscillators were introduced as multiple-prism Littrow (MPL) grating oscillators, or hybrid multiple-prism near-grazing-incidence (HMPGI) grating cavities, in organic dye lasers. However, these designs were quickly adopted for other types of lasers such as gas lasers, diode lasers, and more recently fiber lasers.
Leon Goldman was an American dermatologist and a pioneer in laser medicine. His research areas included the application of lasers in dermatology, cancer photodynamic therapy (PDT) and the use of organic dyes in PDT.
Media related to Laser medicine at Wikimedia Commons
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