Laser surgery

Laser surgery
Intervention
MeSH	D053685

Laser surgery is surgery using 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, and CO₂ are used to treat various skin conditions including scars, vascular and pigmented lesions, and for photorejuvenation.

Eye surgery

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

• ReLEx SMILE, use a femtosecond laser to create a refractive lenticule within the stroma which is then removed through a small incision
• LASIK, in which a knife is used to cut a flap in the cornea, and a laser is used to reshape the layers underneath, to treat refractive error
  • IntraLASIK, a variant in which the flap is also cut with a laser
• Photorefractive keratectomy (PRK, LASEK), in which the cornea is reshaped without first cutting a flap
• Laser thermal keratoplasty, in which a ring of concentric burns is made in the cornea, which cause its surface to steepen, allowing better near vision

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
• 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. Laser recanalization of blocked arteries. other applications include laser assisted angioplasties and laser assisted vascular anastamosis.

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]

Other surgery

The CO₂ laser is also used in gynecology, genitourinary, general and thoracic surgery, otorhinolaryngology, orthopedic, and neurosurgery.^[14]

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. "Laser Surgery". LightScalpel.