Laser surgery

Encyclopedia of Medicine, Apr 06, 2001 by Maureen Haggerty

Laser (light amplification by stimulated emission of radiation) surgery uses an intensely hot, precisely focused beam of light to remove or vaporize tissue and control bleeding in a wide variety of non-invasive and minimally invasive procedures.

Laser surgery is used to:

• Cut or destroy tissue that is abnormal or diseased without harming healthy, normal tissue
• Shrink or destroy tumors and lesions
• Cauterize (seal) blood vessels to prevent excessive bleeding.

Anyone who is thinking about having laser surgery should ask his doctor to:

• Explain why laser surgery is likely to be more beneficial than traditional surgery
• Describe his experience in performing the laser procedure the patient is considering.

Because some lasers can temporarily or permanently discolor the skin of Blacks, Asians, and Hispanics, a dark-skinned patient should make sure that his surgeon has successfully performed laser procedures on people of color.

Some types of laser surgery should not be performed on pregnant women or on patients with severe cardiopulmonary disease or other serious health problems.

The first working laser was introduced in 1960. The device was initially used to treat diseases and disorders of the eye, whose transparent tissues gave ophthalmic surgeons a clear view of how the narrow, concentrated beam was being directed. Dermatologic surgeons also helped pioneer laser surgery, and developed and improved upon many early techniques and more refined surgical procedures.

The three types of lasers most often used in medical treatment are the:

• Carbon dioxide (CO2) laser. Primarily a surgical tool, this device converts light energy to heat strong enough to minimize bleeding while it cuts through or vaporizes tissue.
• Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Capable of penetrating tissue more deeply than other lasers, the Nd:YAG makes blood clot quickly and can enable surgeons to see and work on parts of the body that could otherwise be reached only through open (invasive) surgery.
• Argon laser. This laser provides the limited penetration needed for eye surgery and superficial skin disorders. In a special procedure known as photodynamic therapy (PDT), this laser uses light-sensitive dyes to shrink or dissolve tumors.

Sometimes described as "scalpels of light," lasers are used alone or with conventional surgical instruments in a diverse array of procedures that:

• Improve appearance
• Relieve pain
• Restore function
• Save lives.

Laser surgery is often standard operating procedure for specialists in:

• Cardiology
• Dentistry
• Dermatology
• Gastroenterology (treatment of disorders of the stomach and intestines)
• Gynecology
• Neurosurgery
• Oncology (cancer treatment)
• Ophthalmology (treatment of disorders of the eye)
• Orthopedics (treatment of disorders of bones, joints, muscles, ligaments, and tendons)
• Otolaryngology (treatment of disorders of the ears, nose, and throat)
• Pulmonary care (treatment of disorders of the respiratory system
• Urology (treatment of disorders of the urinary tract and of the male reproductive system).

Routine uses of lasers include erasing birthmarks, skin discoloration, and skin changes due to aging, and removing benign, precancerous, or cancerous tissues or tumors. Lasers are used to stop snoring, remove tonsils, remove or transplant hair, and relieve pain and restore function in patients who are too weak to undergo major surgery. Lasers are also used to treat:

• Angina (chest pain)
• Cancerous or non-cancerous tumors that cannot be removed or destroyed
• Cold and canker sores, gum disease, and tooth sensitivity or decay
• Ectopic pregnancy (development of a fertilized egg outside the uterus)
• Endometriosis
• Fibroid tumors
• Gallstones
• Glaucoma, mild-to-moderate nearsightedness and astigmatism, and other conditions that impair sight
• Migraine headaches
• Non-cancerous enlargement of the prostate gland
• Nosebleeds
• Ovarian cysts
• Ulcers
• Varicose veins
• Warts
• And numerous other conditions, diseases, and disorders.

Often referred to as "bloodless surgery," laser procedures usually involve less bleeding than conventional surgery. The heat generated by the laser keeps the surgical site free of germs and reduces the risk of infection. Because a smaller incision is required, laser procedures often take less time (and cost less money) than traditional surgery. Sealing off blood vessels and nerves reduces bleeding, swelling, scarring, pain, and the length of the recovery period.

Although many laser surgeries can be performed in a doctor's office rather than in a hospital, the person guiding the laser must be at least as thoroughly trained and highly skilled as someone performing the same procedure in a hospital setting. The American Society for Laser Medicine and Surgery, Inc. urges that:

• All operative areas be equipped with oxygen and other drugs and equipment required for cardiopulmonary resuscitation (CPR)
• Non-physicians performing laser procedures be properly trained, licensed, and insured
• A qualified and experienced supervising physician be able to respond to and manage unanticipated events or other emergencies within five minutes of the time they occur
• Emergency transportation to a hospital or other acute-care facility be available whenever laser surgery is performed in a non-hospital setting.