Zapping disease - laser usage in medicine

Vibrant Life, July-August, 1994 by Lidia Wasowicz Pringle

In a giant leap from fiction to fact, the laser has pulsed a long way since Luke Skywalker mustered his courage and aimed the powerful beam at his nemesis Darth Vader.

During the past 17 years the technology has become a weapon in the battle against a more earthly enemy--disease.

The laser is being recruited by surgeons to zap trouble bodywide, particularly beneficial in hard-to-reach or delicate areas with small operative fields, such as the eye, fallopian tube, or mouth.

Specialists boast the high-tech instrument that can minimize such scalpel drawbacks as bleeding, swelling, bruising, scarring, pain, and lengthy recovery. Yet as with any new technology, glitches remain to be worked out.

Lasers--gas, liquid or solid; visible or unseen; of one or more colors; continuous wave or several-billionths-of-a-second pulse--were not all created equal to slice, weld, or obliterate.

"The trick is to know when to use which kind," says Dr. Robert Pick, president of the American Academy of Laser Dentistry.

Mastering the complexities of the laser--which, in the wrong hands, can start fires, harm eyes, char a cheek or chip a tooth, explode, or even electrocute--requires years of practice.

"The laser is not something an unskilled physician could pick up and use," says Dr. Gregory Keller, medical director of the Western Institute for Laser Treatment in Santa Barbara, California.

But properly used, this high-tech tool is performing wonders. Here is a sampling of what it can do:

Ophthalmology. Introduced into medicine as a tool to seal leaking blood vessels in the eye, the laser is widely accepted in surgery for retinal diseases (many suffered by diabetics), glaucoma, and secondary membrane formed after cataract removal.

"Lasers have really turned the tide for many patients who would have gone blind in the past," says Dr. William Ellis, director of the Eye Center of Northern California in El Cerrito.

Obstetrics-Gynecology. Lasers are in demand for gynecologic surgery, the most common operation in the United States, with hysterectomies alone numbering 650,000 a year.

Employed to remove ovarian cysts, unblock fallopian tubes to reverse infertility, and treat urinary incontinence or ectopic pregnancy, lasers also offer an alternative to hysterectomy for uterine bleeding--one that preserves childbearing capability.

Surgeons opt for the laser in about half of procedures for endometriosis, a common disorder resulting when renegade tissue escapes from the uterine lining and colonizes other organs.

"The laser has allowed us to avoid almost all major gynecologic surgeries for benign and malignant conditions," comments Dr. Camran Nezhart, a Stanford University professor who pioneered a revolutionary method called "videolaseroscopy," which gives the surgeon a clear view--and shot--at the abdominal cavity.

"Operating in the uterine cavity is a big step forward in women's medicine, to which lasers lend themselves very well," adds Dr. Michael Baggish, head of ob-gyn at Good Samaritan Hospital in Cincinnati, Ohio.

Dentistry. As bloodless, sutureless negotiators of the curves and folds in the mouth, lasers get high marks in wiping out frenums, the skin flaps under the lip and tongue; canker sores; herpes lesions; oral tumors, and excessive gums.

Recent research has produced good news for ice cream lovers (lasers appear to reduce tooth sensitivity to cold) and dental drill haters (light beams can remove tooth decay, perhaps someday providing a kinder, gentler alternative to the dreaded drill).

Dermatology. Lasers are proving their worth for zapping warts, moles, precancerous lip growths, and the once-permanent tattoos.

"No other method has such a power of removal without blemish or pain," according to Dr. Robin Achinoff, chief of dermatologic and laser surgery at New York University.

Cosmetic surgery. Whether removing a birthmark from a baby's face or wiping away a liver spot from an aging hand, lasers have opened up worlds where cosmetic surgeons previously dared not tread.

"With traditional techniques, these procedures carried unacceptable risks of scarring," says Dr. Gary Lask, associate professor at the University of California, Los Angeles.

San Francisco plastic surgeon Dr. Michael Kulick has traded blade for laser in treating multiple skin malignancies. In the emerging "photodynamic therapy," laser light selectively activates drugs to kill the cancer without harming healthy cells.

Urology. Urologists use lasers to zap polyps that can develop into colon cancer and, in a much newer application, to vaporize tissue blocking the flow of urine in a high-tech takeoff on the traditional prostatectomy, men's second most common operation. As Dr. Maurice Sandler of Brookside Hospital in San Pablo, California, says: "The laser is ideal for some small enlargements of the prostate. No cutting, no bleeding."

Gastroenterology. Lasers speedily fragment gallstones trapped in the common duct between the liver and intestine, allowing their retrieval and stymieing a potentially deadly condition.