State of the Art Laser Surgery
What is a laser?
LASER stands for Light Amplification by Stimulated Emission of Radiation. A laser is an opto-electronic device that produces highly concentrated light rays. Laser power may range from milliWatts (in CD-ROM drives and laser pointers) to dozens of Watts (industrial and medical applications) and over trillions of Watts (pulsed lasers in scientific and military applications).
What is laser surgery?
Interaction of laser light with tissue provides a fundamentally different approach to surgery. In laser surgery, a highly focused laser beam can efficiently ablate (either vaporize or chip away) the living tissue. At the same time, it seals (welds) capillaries, small blood vessels, lymphatics, and nerve endings, with significant benefits to both patients and surgeons.
What is the most efficient soft-tissue surgical laser?
Soft Tissue Laser Surgery is different from Hard Tissue Laser Surgery (bones and teeth in dentistry) and Laser Eye Surgery (eye sight corrective surgeries) by particular types of lasers. Lasers differ from each other by the wavelength of light they produce. The most commonly used surgical laser in soft tissue surgery is the CO2 laser. The CO2 laser wavelength (10.6 micrometers) is highly absorbed by water contained in soft tissue. Because of its outstanding versatility and precision, the CO2 surgical laser is the most efficient and dominant soft tissue surgical laser since the 1960s. Laser surgery is widely practiced in many applications of human as well as veterinary medicine.
Laser surgery offers better hemostasis (blood control) and visibility, less post-operative swelling, and decreased post-operative pain. In certain procedures, better hemostasis and visibility will reduce overall surgical time.
Laser surgery benefits for patients
- Less Bleeding: As it cuts, the laser seals small blood vessels. This drastic reduction in bleeding enables a number of new surgical procedures that are not practical with conventional scalpel.
- Less Pain: The CO2 laser beam seals nerve endings and lymphatics, resulting in less edema and pain. The patient experiences a far more comfortable post-operative recovery, much less pain.
- Reduced risk of infection: This is one of the unique features of the CO2 laser beam. It efficiently kills bacteria in its path, producing a sterilizing effect.
- Quicker recovery time: Reduced risk of infection, less bleeding, less pain and less swelling often allow the patient a far quicker recovery after the surgery.
Laser surgery benefits for surgeons
- Unique surgical capabilities: Laser surgery improves many surgical procedures by making them simpler and reducing risk. This enables surgeries that are not practical with conventional methods.
- Enhanced visibility of the surgical field: The laser light seals capillaries and small blood vessels as it cuts, thereby dramatically reducing bleeding. This results in a much clearer and drier surgical site.
- Increased precision and control: The focal spot size of the beam may be adjusted down to a small fraction of a millimeter or expanded for a much wider coverage. The laser power may be set for rapid removal of relatively large tissue amounts, or adjusted to remove only one cell layer at a time.
- Reduction of surgery time: The hemostatic effect of the laser beam and the improved visibility of the surgical field often reduce the duration of the surgery.
Veterinary Laser Surgery
General surgery procedures:
Traumatic wound debridement, Perianal tumors, Toe Nail Lasing, Amputations, Tumor bed ablations, Ceruminous adenocarcinoma, Vaginal Fold Excision, Chemodectoma Chronic, Mast cell tumors, Colorectal tumor debulking or resection, Cranial cruciate ligament rupture debridement, Granulation tissue shaving, Cystotomy, Deep mass removal, Everted saccule resection, Vital pulpotomy, Fibrosarcoma, Graft bed preparation-infected wounds, Hemangiopericytoma, Hepatic carcinoma – hepatic lobectomy, Lipoma & Liposarcoma resections, Operculectomy, Perianal urethostomy stricture revisions, Pericardectomy, Rhabdomyxoma of flank, Subtotal prostatectomy, Tendon sheath tumors hemangiopericytoma, SCC and infiltrating lipoma, Thyroidectomy, Enterotomy, Transitional cell carcinoma of bladder, Perianal fistulas, Tumor/mass removal, Urethral prolapse resections, Urinary bladder polyps, Vaginal tumor excisions – leiomyoma, SCC and fibrosarcoma, Anal saculectomy.
The carbon dioxide laser is a very effective tool for treating diseases of the perianal region. The skin of the perianal region is thin and sensitive. The carbon dioxide laser offers a‘no touch’ method of excising these lesions, which helps decrease postoperative discomfort and irritation. The carbon dioxide laser is very effective in controlling hemorrhage from vessels smaller than 0.5 mm. This is sufficient in controlling most hemorrhage caused from the rich blood supply of the perianal region. The perianal region is contaminated with bacteria. The carbon dioxide laser photothermally vaporizes bacteria, so that bacterial numbers are decreased, which helps reduce the risk of postoperative infections. These factors help the patient recover quicker and return to function sooner.
The light emitted from a carbon dioxide laser has a wavelength of 10,600 nm, which is in the far-infrared light spectrum. This wavelength of light is highly absorbed by water, creating a thermal effect. Because all soft tissues in the body are composed mainly of water, the carbon dioxide laser penetrates very shallow into tissue, and there is very little collateral thermal damage. This interaction makes the carbon dioxide laser a useful tool for incising, excising, and photoablating soft tissue and allows for fine, controlled dissection of tissue. The axiom of ‘what you see is what you get’ applies to the properties of the carbon dioxide laser. Finally, the carbon dioxide laser seems to have a lower learning curve when compared with other types of lasers.
The CO2 laser proved to be an excellent choice for laser surgery because of the ability to limit the zones of damage to microsurgery with little to no damage to healthy tissue.