Laser surgery

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Laser surgery

MeSH D053685

[edit on Wikidata]

Laser surgery is a type of surgery that uses a laser (in contrast to using 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 the
human tissue. [4][5][6]
Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and Potassium titanyl
phosphate, from among others.

Contents
[hide]

 1Effects
 2Applications
o 2.1Dermatology and plastic surgery
o 2.2Eye surgery
o 2.3Endovascular surgery
o 2.4Foot and ankle surgery
o 2.5Gastro-intestinal tract
o 2.6Oral and dental surgery
o 2.7Spine surgery
o 2.8Other surgery
 3References

Effects[edit]
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[edit]
Dermatology and plastic surgery[edit]
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[edit]
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[edit]
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[edit]
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[edit]

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

AD V ER T IS E M E N T

Laser Therapy







 Uses

 Preparation

 Procedure

 Types
 Risks

 Benefits

 Recovery

What is laser therapy?

Laser therapies are medical treatments that use focused light. Unlike most light
sources, light from a laser (which stands for light amplification
by stimulated emission of radiation) is tuned to specific wavelengths. This allows it
to be focused into powerful beams. Laser light is so intense that it can be used to
shape diamonds or cut steel.

In medicine, lasers allow surgeons to work at high levels of precision by focusing

on a small area, damaging less of the surrounding tissue. If you have laser therapy,
you may experience less pain, swelling, and scarring than with traditional surgery.
However, laser therapy can be expensive and require repeated treatments.

USES

What is laser therapy used for?

Laser therapy may be used to:

 shrink or destroy tumors, polyps, or precancerous growths

 relieve symptoms of cancer
 remove kidney stones
 remove part of the prostate
 repair a detached retina
  improve vision
 treat hair loss resulting from alopecia or aging
 treat pain, including back nerve pain
Lasers can have a cauterizing, or sealing, effect and may be used to seal:

 nerve endings to reduce pain after surgery

 blood vessels to help prevent blood loss
 lymph vessels to reduce swelling and limit the spread of tumor cells
Lasers may be useful in treating the very early stages of some cancers, including:

 cervical cancer
 penile cancer
 vaginal cancer
 vulvar cancer
 non-small cell lung cancer
 basal cell skin cancer
For cancer, laser therapy is usually used alongside other treatments, such as
surgery, chemotherapy, or radiation.

Laser therapy is also used cosmetically to:

 remove warts, moles, birthmarks, and sun spots

 remove hair
 lessen the appearance of wrinkles, blemishes, or scars
 remove tattoos
Who shouldn’t have laser therapy?

Some laser surgeries, such as cosmetic skin and eye surgeries, are considered
elective surgeries. Some people decide the potential risks can outweigh the
benefits of these types of surgeries. For example, some health or skin conditions
may be aggravated by laser surgeries. As with typical surgery, poor overall health
also increases your risk of complications.

Talk to your doctor before deciding to undergo laser surgery for any kind of
operation. Based on your age, overall health, healthcare plan, and the cost of laser
surgery, your doctor may recommend that you choose traditional surgical
methods. For example, if you’re younger than 18 years, you should not get Lasik
eye surgery.

PREPARATION

How do I prepare for laser therapy?

Plan ahead to ensure that you have time to recover after the operation. Also make
sure someone can take you home from the procedure. You will likely still be under
the influence of anesthesia or medications.

A few days before the surgery, you may be advised to take precautions such as
stopping any medications that can affect blood clotting, such as blood thinners.

AD V ER T IS E M E N T
PROCEDURE

How is laser therapy done?

Laser therapy techniques vary based on the procedure.

If a tumor is being treated, an endoscope (a thin, lighted, flexible tube) may be

used to direct the laser and view tissues inside the body. The endoscope is
inserted through an opening in the body, such as the mouth. Then, the surgeon
aims the laser and shrinks or destroys the tumor.

In cosmetic procedures, lasers are usually applied directly to the skin.

TYPES

What are the different types?

Some common laser surgeries include:

 refractive eye surgery (often called LASIK)

 tooth whitening
 cosmetic scar, tattoo, or wrinkle removal
 cataract or tumor removal
Read more: LASIK eye surgery »

Different lasers are used for different procedures. For example, carbon dioxide
(CO2) lasers make shallow cuts. They’re often used for superficial cancers, such as
skin cancer.

Argon lasers also make shallow cuts and can be used to activate photosensitizing
(light-activated) drugs during photodynamic therapy. This type of cancer
treatment combines light with chemotherapy to kill more cancer cells.

Nd:YAG lasers can travel along optical fibers. They’re used in laser-induced
interstitial thermotherapy, a type of cancer treatment.

Low level laser therapy (LLLT) is also called cold laser therapy. It uses laser light set
to wavelengths between 600 and 980 nanometers. The laser is used to perform
minor surgeries and promote regeneration in tissue. Programs exist that offer LLLT
as an aid to quit smoking, but little evidence supports its use for this purpose.

RISKS

What are the risks?

Laser therapy has some risks. The risks for skin therapy include:

 bleeding
 infection
 pain
 scarring
  changes in skin color
Also, the intended effects of treatment may not be permanent, so repeated
sessions may be necessary.

Some laser surgery is performed while you’re under general anesthesia, which
carries its own set of risks. They include:

 pneumonia
 confusion after waking from the operation
 heart attack
 stroke
Treatments can also be expensive and are therefore not accessible to everyone.
Laser eye surgery can cost anywhere from $600 to $8,000 or more based on your
healthcare plan and the provider or facility you use for your surgery. The costs of
laser skin therapies can range from $200 to over $3,400, according to
the University of Michigan Cosmetic Dermatology & Laser Center.

AD V ER T IS E M E N T
BENEFITS

What are the benefits?

Lasers are more precise than traditional surgical instruments, and cuts can be
made shorter and shallower. This causes less damage to tissue.

Laser operations are usually shorter than traditional surgeries. They can often be
done on an outpatient basis. You also don’t have to spend the night in the
hospital. If general anesthesia is required, it’s usually used for a shorter time.

People also tend to heal faster with laser operations. You may have less pain,
swelling, and scarring than with traditional surgeries.

RECOVERY

What happens after laser therapy?

Recovery after laser surgeries is similar to that of typical surgery. You may need to
rest for the first few days after the operation and take over-the-counter pain
medication until the discomfort and swelling have gone down.

Recovery after laser therapy varies based on the type of therapy you received and
how much of your body was affected by the therapy.

You should follow any orders your doctor gives you very closely. For example, if
you have laser prostate surgery, you may need to wear a urinary catheter. This can
aid in urinating right after the surgery.

If you received therapy on your skin, you may experience swelling, itching, and
rawness around the treated area. Your doctor may use an ointment and dress up
the area so that it’s airtight and watertight.

For the first couple of weeks after the treatment, be sure to do the following:

 Use over-the-counter medications for pain, such as ibuprofen (Advil)

or acetaminophen (Tylenol).
 Clean the area regularly with water.
 Apply ointments, such as petroleum jelly.
 Use ice packs.
 Avoid picking any scabs.