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Laser surgery is a type of
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
that uses a
laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The ...
(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 Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ...
with high
water Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as ...
content. Laser surgery is commonly used on the eye. Techniques used include
LASIK LASIK or Lasik (''laser-assisted in situ keratomileusis''), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism (eye), ...
, which is used to correct near and far-sightedness in vision, and
photorefractive keratectomy Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (or laser epithelial keratomileusis) (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lense ...
, a procedure which permanently reshapes the cornea using an
excimer laser An excimer laser, sometimes more correctly called an exciplex laser, is a form of ultraviolet laser which is commonly used in the production of microelectronic devices, semiconductor based integrated circuits or "chips", eye surgery, and microm ...
to remove a small amount of the human tissue. Types of surgical lasers include
carbon dioxide Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is t ...
,
argon Argon is a chemical element with the symbol Ar and atomic number 18. It is in group 18 of the periodic table and is a noble gas. Argon is the third-most abundant gas in Earth's atmosphere, at 0.934% (9340 ppmv). It is more than twice a ...
, Nd:YAG laser, and potassium titanyl phosphate, among others.


Effects

#
Photochemical effect Photochemistry is the branch of chemistry concerned with the chemical effects of light. Generally, this term is used to describe a chemical reaction caused by absorption of ultraviolet (wavelength from 100 to 400  nm), visible light (400– ...
: clinically referred to as photodynamic therapy.
Photosensitizer Photosensitizers produce a physicochemical change in a neighboring molecule by either donating an electron to the substrate or by abstracting a hydrogen atom from the substrate. At the end of this process, the photosensitizer eventually returns t ...
(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 oesophageal and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder. # Photoablative effect: Used in eye surgeries like band keratoplasty, and endartectomy of peripheral blood vessels. # Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophageal varices # Photomechanical effect: used in intraluminal lithotripsy


Equipment

Surgical laser systems, sometimes called "laser scalpels", are differentiated not only by the wavelength, but also by the light delivery system: flexible fiber or articulated arm, as well as by other factors. CO2 lasers were the dominant soft-tissue surgical lasers as of 2010.


Applications


Soft tissue

Soft-tissue laser surgery is used in a variety of applications in humans (
general surgery General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thy ...
,
neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
,
ENT Ents are a species of beings in J. R. R. Tolkien's fantasy world Middle-earth who closely resemble trees; their leader is Treebeard of Fangorn forest. Their name is derived from an Old English word for giant. The Ents appear in ''The Lor ...
,
dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of ...
,
orthodontics Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, and misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial ...
, and oral and maxillofacial surgery) as well as veterinary surgical fields. The primary uses of lasers in soft tissue surgery are to cut, ablate, vaporize, and coagulate. There are several different laser wavelengths used in soft tissue surgery. Different laser wavelengths and device settings (such as pulse duration and power) produce different effects on the tissue. Some commonly used lasers types in soft tissue surgery include erbium,
diode A diode is a two-terminal electronic component that conducts current primarily in one direction (asymmetric conductance); it has low (ideally zero) resistance in one direction, and high (ideally infinite) resistance in the other. A diod ...
, and CO2. Erbium lasers are excellent cutters, but provide minimal hemostasis. Diode lasers (hot tip) provide excellent hemostasis, but are slow cutters. CO2 lasers are both efficient at cutting and coagulating.


Dermatology and plastic surgery

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 bypasses the skin surface. The principle of laser surgery for dermatologic problems 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 the removal of unwanted tissue by laser surgery. Laser resurfacing is a technique in which
covalent bond A covalent bond is a chemical bond that involves the sharing of electrons to form electron pairs between atoms. These electron pairs are known as shared pairs or bonding pairs. The stable balance of attractive and repulsive forces between ato ...
s 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. Lasers are also used for laser-assisted
lipectomy Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, lipo ...
.


Eye surgery

Various types of laser surgery are used to treat
refractive error Refractive error, also known as refraction error, is a problem with focusing light accurately on the retina due to the shape of the eye and or cornea. The most common types of refractive error are near-sightedness, far-sightedness, astigmatism ...
.
LASIK LASIK or Lasik (''laser-assisted in situ keratomileusis''), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism (eye), ...
, in which a knife is used to cut a flap in the
cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...
, and a laser is used to reshape the layers underneath, is used to treat refractive error. IntraLASIK is a variant in which the flap is also cut with a laser. In
photorefractive keratectomy Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (or laser epithelial keratomileusis) (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lense ...
(PRK, LASEK), the cornea is reshaped without first cutting a flap. In laser thermal keratoplasty, a ring of concentric burns is made in the cornea, which causes its surface to steepen, allowing better near vision. ReLEx SMILE is the latest advancement in laser vision correction technology. In SMILE surgery, ZEISS VisuMax ® femtosecond laser is used to make a small incision and to create a pre-calculated mini lens tissue (or lenticule) inside the cornea. 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 and 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 The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which the ...
.


Endovascular surgery

Laser
endarterectomy Endarterectomy is a surgical procedure to remove the atheromatous ''plaque'' material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall. It was first ...
is a technique in which an entire atheromatous plaque in the artery is excised. Other applications include laser assisted
angioplasties Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscleros ...
and laser-assisted vascular
anastomosis An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be norm ...
.


Foot and ankle surgery

Lasers are used to treat several disorders in
foot and ankle surgery Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of c ...
. They are used to remove benign and malignant tumors, treat bunions, debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and
keloids Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation ...
, and the removal of hypertrophic scars and tattoos. A
carbon dioxide laser The carbon-dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed. It was invented by Kumar Patel of Bell Labs in 1964 and is still one of the most useful types of laser. Carbon-dioxide lasers are the highest-power contin ...
(CO2) is used in surgery to treat onychocryptosis (ingrown nails), onychauxis (club nails), onychogryposis (rams horn nail), and onychomycosis (fungus nail).


Gastro-intestinal tract

#
Peptic ulcer disease Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines ...
and oesophageal varices - Laser photoablation is done. # Coagulation of
vascular malformation A vascular malformation is a blood vessel or lymph vessel abnormality. Vascular malformations are one of the classifications of vascular anomalies, the other grouping is vascular tumors. They may cause aesthetic problems as they have a growth cyc ...
s of stomach,
duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine m ...
, and colon. # Lasers can be effectively used to treat early
gastric cancer Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes, including gastric adenocarcinomas. Lym ...
s provided they are less than 4 cm and without
lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
involvement. Lasers are also used in treating oral submucous fibrosis. # 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 a soft diet and maintain hydration. # Ablative laser therapy is used in advanced
colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel ...
s to relieve obstruction and to control bleeding. # Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal. # Laser-assisted liver resections have been done using
carbon dioxide Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is t ...
and Nd:YAG lasers. # The ablation of liver tumors can be achieved by selective photovaporization of the tumor. #
Endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...
laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.


Oral and dental surgery

The CO2 laser is used in oral and
dental surgery Dental surgery is any of a number of medical procedures that involve artificially modifying dentition; in other words, surgery of the teeth, gums and jaw bones. Types Some of the more common are: * Endodontic (surgery involving the pulp or root ...
for virtually all soft-tissue procedures, such as gingivectomies, vestibuloplasties, frenectomies, and operculectomies. 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.


Spine surgery

Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within discectomy to treat
lumbar disc disease Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica. In this arti ...
under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain. 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. Evidence-based data surrounding the use of lasers in spine surgery is limited and its safety and efficacy were poorly understood as of 2017.


Thoracic surgery

In
thoracic surgery Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal stru ...
, surgical laser applications are most often used to remove pulmonary metastases and tumors of different primary localizations. Other areas of application are surgical sectioning of the parenchyma, anatomic segmental resections, removal of tumors from the thoracic wall and abrasion of the pleura parietalis. Since the introduction of surgical lasers, the amount of potentially surgically resectable pulmonary nodules has significantly increased. Compared to laser surgery, other conventional surgical methods such as segmental or wedge resections with surgical stapling will normally lead to a bigger loss of lung tissue, especially in patients with multiple pulmonary nodules methods.Mineo TC, Cristino B, Ambrogi V et al. Usefulness of the Nd: YAG laser in parenchyma-sparing resection of pulmonary nodular lesions. Tumori 1994; 80(5):365-369 Other advantages of laser surgery compared to conventional methods are that it leads to an improved postoperative lung function and that it gives the additional possibility to histologically analyze the removed material which would otherwise be destroyed through radiation or heat.


Other surgery

The CO2 laser is also used in
gynecology Gynaecology or gynecology (see American and British English spelling differences, spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with ...
, genitourinary,
general surgery General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thy ...
,
otorhinolaryngology Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...
, orthopedic, and
neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
.


Hard tissues

Lasers are used to cut or ablate
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
s and
teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, ...
in
dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of ...
.


References

{{Lasers Laser applications Laser medicine Surgery