Laser surgery

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Laser surgery
MeSH D053685

Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel. [1]

Contents

Soft-tissue laser surgery is used in a variety of applications in humans (general surgery, neurosurgery, ENT, dentistry, orthodontics, [2] and oral and maxillofacial surgery) as well as veterinary [3] surgical fields. The primary uses of lasers in soft tissue surgery are to cut, ablate, vaporize, and coagulate. There are several different laser wavelengths used in soft tissue surgery. Different laser wavelengths and device settings (such as pulse duration and power) produce different effects on the tissue. Some commonly used lasers types in soft tissue surgery include erbium, diode, and CO2. Erbium lasers are excellent cutters, but provide minimal hemostasis. Diode lasers (hot tip) provide excellent hemostasis, but are slow cutters. CO2 lasers are both efficient at cutting and coagulating. [4] 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 the human tissue. [5] [6] [7]

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 oesophageal and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
  2. Photoablative effect: Used in eye surgeries like band keratoplasty, and endartectomy of peripheral blood vessels.
  3. Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophageal varices
  4. Photomechanical effect: used in intraluminal lithotripsy

Equipment

A 40 watt CO2 laser used for soft-tissue laser surgery Sharplan 40C.jpg
A 40 watt CO2 laser used for soft-tissue laser surgery

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] Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and potassium titanyl phosphate. 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.

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. [10] [11]

Lasers are also used for laser-assisted lipectomy. [12]

Eye surgery

Various types of laser surgery are used to treat refractive error. LASIK, in which a knife is used to cut a flap in the cornea, and a laser is used to reshape the layers underneath, is used to treat refractive error. IntraLASIK is a variant in which the flap is also cut with a laser. In photorefractive keratectomy (PRK, LASEK), the cornea is reshaped without first cutting a flap. In laser thermal keratoplasty, a ring of concentric burns is made in the cornea, which causes its surface to steepen, allowing better near vision. ReLEx SMILE is the latest advancement in laser vision correction technology. In SMILE surgery, ZEISS VisuMax femtosecond laser is used to make a small incision and to create a pre-calculated mini lens tissue (or lenticule) inside the cornea. [13]

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 endarterectomy is a technique in which an entire atheromatous plaque in the artery is excised. 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, [14] treat bunions, [15] debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and keloids, and the removal of hypertrophic scars and tattoos. [16]

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). [17]

Gastro-intestinal tract

  1. Peptic ulcer disease and oesophageal varices - Laser photoablation is done.
  2. Coagulation of vascular malformations of stomach, duodenum, and colon.
  3. 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.
  4. 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 a soft diet and maintain hydration.
  5. Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
  6. Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
  7. Laser-assisted liver resections have been done using carbon dioxide and Nd:YAG lasers.
  8. The ablation of liver tumors can be achieved by selective photovaporization of the tumor.
  9. 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 gingivectomies, vestibuloplasties, frenectomies, and operculectomies. [18] 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. [19]

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 thoracic surgery, surgical laser applications are most often used to remove pulmonary metastases and tumors of different primary localizations. [25] Other areas of application are surgical sectioning of the parenchyma, anatomic segmental resections, removal of tumors from the thoracic wall [26] and abrasion of the pleura parietalis. Since the introduction of surgical lasers, the amount of potentially surgically resectable pulmonary nodules has significantly increased. [27] Compared to laser surgery, other conventional surgical methods such as segmental or wedge resections with surgical stapling will normally lead to a bigger loss of lung tissue, especially in patients with multiple pulmonary nodules methods. [28]

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.

Related Research Articles

<span class="mw-page-title-main">Farsightedness</span> Eye condition in which light is focused behind instead of on the retina

Far-sightedness, also known as long-sightedness, hypermetropia, and hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blur is due to incoming light being focused behind, instead of on, the retina due to insufficient accommodation by the lens. Minor hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain of eye strain during prolonged reading. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, but it gradually decreases as the newborn gets older.

<span class="mw-page-title-main">LASIK</span> Corrective ophthalmological surgery

LASIK or Lasik, commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is performed by an ophthalmologist who uses a femtosecond laser or a microkeratome to create a corneal flap to expose the corneal stroma and then an excimer laser to reshape the corneal stroma in order to improve visual acuity.

<span class="mw-page-title-main">Photorefractive keratectomy</span> Refractive eye surgery procedure

Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lenses. LASEK and PRK permanently change the shape of the anterior central cornea using an excimer laser to ablate a small amount of tissue from the corneal stroma at the front of the eye, just under the corneal epithelium. The outer layer of the cornea is removed prior to the ablation.

A microkeratome is a precision surgical instrument with an oscillating blade designed for creating the corneal flap in LASIK or ALK surgery. The normal human cornea varies from around 500 to 600 μm in thickness; and in the LASIK procedure, the microkeratome creates an 83 to 200 μm thick flap. The microkeratome uses an oscillating blade system, which has a blade that oscillates horizontally as the blade travels vertically for a precise cut. This piece of equipment is used all around the world to cut the cornea flap. The microkeratome is also used in Descemet's stripping automated endothelial keratoplasty (DSAEK), where it is used to slice a thin layer from the back of the donor cornea, which is then transplanted into the posterior cornea of the recipient. It was invented by Jose Barraquer and Cesar Carlos Carriazo in the 1950s in Colombia.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

<span class="mw-page-title-main">Refractive surgery</span> Surgery to treat common vision disorders

Refractive surgery is an optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

<span class="mw-page-title-main">Er:YAG laser</span>

An Er:YAG laser (erbium-doped yttrium aluminium garnet laser, erbium YAG laser) is a solid-state laser whose active laser medium is erbium-doped yttrium aluminium garnet (Er:Y3Al5O12). Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light.

A dental laser is a type of laser designed specifically for use in oral surgery or dentistry.

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.

<span class="mw-page-title-main">Pellucid marginal degeneration</span> Degenerative corneal condition

Pellucid marginal degeneration (PMD) is a degenerative corneal condition, often confused with keratoconus. It typically presents with painless vision loss affecting both eyes. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It is typically characterized by a clear, bilateral thinning (ectasia) in the inferior and peripheral region of the cornea, although some cases affect only one eye. The cause of the disease remains unclear.

<span class="mw-page-title-main">Frenectomy</span> Surgical removal of a frenulum

A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.

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.

<span class="mw-page-title-main">Laser medicine</span>

Laser medicine is the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy, photorejuvenation, and laser surgery.

<span class="mw-page-title-main">Gholam A. Peyman</span> Iranian-American ophthalmologist and retina surgeon known for inventing LASIK eye surgery

Gholam A. Peyman is an Iranian American ophthalmologist, retina surgeon, and inventor. He is best known for his invention of LASIK eye surgery, a vision correction procedure designed to allow people to see clearly without glasses. He was awarded the first US patent for the procedure in 1989.

Peter S. Hersh is an American ophthalmologist, researcher, and specialist in LASIK eye surgery, keratoconus, and diseases of the cornea. He co-authored the article in the journal Ophthalmology that presented the results of the study that led to the first approval by the U.S. Food and Drug Administration (FDA) of the excimer laser for the correction of nearsightedness in the United States. Hersh was also medical monitor of the study that led to approval of corneal collagen crosslinking for the treatment of keratoconus. He was the originator, in 2015, of CTAK for keratoconus, patent holder, and co-developer.

<span class="mw-page-title-main">Michael H. Wynn</span> American podiatrist (born 1953)

Michael H. Wynn, D.P.M. is an American podiatrist practicing in Kingwood, Texas, specializing in surgical application of lasers in the treatment of foot and ankle disorders and carbon dioxide laser treatment of bunions.

<span class="mw-page-title-main">Alexey Severtsev</span>

Alexey Nikolaevich Severtsev – a Russian doctor of medicine sciences, professor in the hospital surgery department of the medical faculty in Pirogov Russian National Research Medical University and the chief surgeon of a chain of clinics “MEDSI”.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

Lasers are used to treat cancer in several different ways. Their high-intensity light can be used to shrink or destroy tumors or precancerous growths. Lasers are most commonly used to treat superficial cancers such as basal-cell skin cancer and the very early stages of some cancers, such as cervical, penile, vaginal, vulvar, and non-small cell lung cancer.

References

  1. ↑ "General Surgery". American Society for Laser Medicine and Surgery. May 20, 2016. Retrieved 2024-08-21.
  2. ↑ Borzabadi-Farahani A (2017). "The Adjunctive Soft-Tissue Diode Laser in Orthodontics". Compend Contin Educ Dent. 37 (eBook 5): e18–e31. PMID   28509563.
  3. ↑ Noel A. Berger; Peter H. Eeg (9 January 2008). Veterinary Laser Surgery: A Practical Guide. John Wiley & Sons. ISBN   978-0-470-34412-5.
  4. ↑ Strauss, Robert (2017-03-08). "24". In Fonseca, Raymond J. (ed.). Oral and Maxillofacial Surgery - E-Book: 3-Volume Set. Elsevier Health Sciences. pp. 327–354. ISBN   9780323444422.
  5. ↑ Cuscheri; et al. "Essential Surgical Practice". Basic surgical training (4 ed.). pp. 62–65.
  6. ↑ Schwesinger, WH; Hunter, JG (1992). Laser in General Surgery. Surgical Clinics of North America.
  7. ↑ Morris, Peter J; Wood, William C. Oxford Textbook of Surgery. Vol. 2.
  8. ↑ 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.
  9. ↑ Convissar, Robert A. (2010-05-19). Principles and Practice of Laser Dentistry - E-Book. Elsevier Health Sciences. ISBN   978-0323079891.
  10. ↑ 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.
  11. ↑ Roberts, Thomas L III; Lettieri, John T; Ellis, Laura B. (1996). "CO2 Laser Resurfacing: Recognizing and Minimizing Complications". Aesthetic Surgery Journal. 16 (2). American Society for Aesthetic Plastic Surgery: 142–148. doi: 10.1016/S1090-820X(96)70038-9 .
  12. ↑ Fakhouri, TM; El Tal, AK; Abrou, AE; Mehregan, DA; Barone, F (February 2012). "Laser-assisted lipolysis: a review". Dermatologic Surgery. 38 (2): 155–69. doi:10.1111/j.1524-4725.2011.02168.x. PMID   22093156. S2CID   32295300.
  13. ↑ "ReLEx SMILE Surgery & Procedures in Toronto". Clearview Vision Institute. Retrieved 2020-05-06.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ Levine, Robert; Vitruk, Peter (2015). "Laser-Assisted Operculectomy". Compend Contin Educ Dent. 36 (8): 561–567. PMID   26355439.
  19. ↑ 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.
  20. ↑ Quigley, M. R.; Maroon, J. C. (1994-01-01). "Laser discectomy: a review". Spine. 19 (1): 53–56. doi:10.1097/00007632-199401000-00010. ISSN   0362-2436. PMID   8153804.
  21. ↑ Ascher, P. W.; Heppner, F. (1984). "CO2-Laser in neurosurgery". Neurosurgical Review. 7 (2–3): 123–133. doi:10.1007/bf01780695. ISSN   0344-5607. PMID   6436735. S2CID   23392627.
  22. ↑ 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: 293582. doi: 10.1155/2014/293582 . ISSN   2314-6133. PMC   4055392 . PMID   24967347.
  23. ↑ Stern, Jack (October 2009). "Lasers in Spine Surgery: A Review" (PDF). www.Spine.org.
  24. ↑ "Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)". providers.bcidaho.com. Retrieved 2017-06-21.
  25. ↑ Rolle A, Thetter O, Häussinger K. et al. Einsatz des Nd:YAG-Lasers in der Thoraxchirurgie. Herz Gefäß Thorax Chir 1989; 3:85-91
  26. ↑ Inderbitzi R, Rolle A. Palliative surgery for primary and secondary thoracic malignancies. Ther Umsch 2001 Jul;58(7) 435-41
  27. ↑ 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
  28. ↑ 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
  29. ↑ Donald J. Coluzzi; Robert A. Convissar (2007). Atlas of Laser Applications in Dentistry. Quintessence Publishing Company. ISBN   978-0-86715-476-4.
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