Editorial Feature

How Lasers Are Used for Precise Surgical Work

Image Credits: Baciu/shutterstock.com

Leon Goldman first pioneered laser surgery by using lasers to treat cutaneous melanoma, in 1961, in his dermatologic practice. In 1966 he again became the first to use lasers for tumor removal. He went on to become a founder of the American Society for Laser Medicine and Surgery (ASLMS) in 1979.

Surgical Applications

Lasers have made great advances in the field of surgical applications. This is because of its collimated and intense beam which releases high energy in the targeted tissue, but can be adjusted to minimize collateral damage.

The ability to focus the laser beam allows precise cutting or ablation of tissue, instead of using a steel scalpel. Other advantages of using a laser beam for surgery include the reduction in pain and tissue contact, resulting in less pain and shorter recovery times, and excellent control of bleeding. As a result lasers are being used in diverse areas such as:

  • Removing tumors in difficult or inaccessible locations with less difficulty and tissue damage
  • Treating superficial growths and very early skin tumors
  • Removal of tumors in the female pelvic organs
  • Cosmetic and dermatologic procedures including scar removal, skin resurfacing, and vascular tumor treatment
  • Direct tumor removal
  • Debulking or shrinking obstructing growths in the trachea, esophagus, bronchial tree and colon, to relieve symptoms such as dyspnea, dysphagia or obstructed bowel. Lasers are also useful in removing secondary tumors from lung tissue, in place of excising large lung segments surgically, as the latter would require prolonged recovery times and cause greater pain and suffering. Such palliative techniques are important in improving the quality of life in patients who cannot be cured of their cancer.
  • Laser treatment of many malignant neoplasms of the head, neck, lungs and airways, and some vocal cord tumors

Increasing the Precision of Laser Surgery

Laser surgery is ever advancing in effectiveness and accuracy. The following factors help achieve spot precision:

Wavelength

Infra-red region lasers such as the CO2 and Nd:YAG lasers are preferred to reduce tumor size or remove tumors. Near- infrared lasers are weakly absorbed by tissues compared to infrared and mid infrared lasers. Increasing the laser power causes more collateral damage, however.

Use of Flexible Optics

They are often used with endoscopes for internal procedures on the stomach or urologic organs. Other lasers can be fitted to flexible fiberoptics to allow surgery in deeper parts of the body without big incisions. Endoscopic visualization allows precise placement of the laser beam.

Spot Size

By adjusting the spot size the precision of laser surgery can be optimized while avoiding collateral tissue damage due to excessive penetration of the laser beam.  

Laser Mode

Choosing the right laser mode is essential in achieving the optimal results with good coagulation parameters but minimal tissue damage outside the operating zone. The use of pulsed laser allows greater but more focused power than continuous wave lasers.

Microsurgery

Another way in which lasers improve accuracy is by coupling them with low-power microscopes which magnify the operating area. The use of micromanipulators allows fine movements within as little as 200 microns.

Image Credits: withGod/shutterstock.com

Constant Improvement

The principle underlying the surgical laser ought to ensure its ability to achieve single-cell resolution and thus help to perform minimally invasive procedures. The problem with this goal has been the thermal and mechanical damage to adjacent tissue.

Early on, continuous wave (CW) lasers were in use. The discovery of the CO2 laser allows laser incisions and tissue excision, while the argon laser is more useful in eye and skin surgery. The Nd:YAG laser is used alone or after passing it through the KTP (potassium titanyl phosphate) crystal for frequency doubling to operate on the eye or for laparoscopic procedures. CW lasers have the unpleasant feature of causing non-selective photothermal tissue-laser interactions with collateral tissue damage. The need for a long period of learning and much experience limited their clinical application to a few centers at first.

Selective Photothermolysis

However, Richard Anderson and John Parrish introduced selective photothermolysis in 1983, using lasers which are absorbed only by cells containing specific pigments for each type of laser used, and short laser pulses. This innovation led to the availability of precisely induced heat injury to treat vascular and pigmented skin lesions without significant scarring, using very short pulses to target only pigmented cells. There is no need for precise focusing of the laser beam upon a particular cell because the selectivity is provided by the optical pigment itself.

The key determinants for accurate treatment in this method are the threshold fluence and the thermal relaxation time. The threshold fluence is taken advantage of to ensure precise and controlled damage zones by adjusting the wavelength, the fluence and the pulse duration. Multiple synchronized pulsing is a technique used to minimize nonspecific epidermal damage due to its high pigment content.

This led to the widespread use of the pulsed yellow dye laser to treat vascular lesions, and later the development of Q-switched lasers at very short pulses for highly targeted treatment of pigmented lesions and tattoos.

Scanning Lasers

In the 1990s scanning technology was coupled with the CO2 and Er:YAG lasers to provide computerized laser control. This resulted in the development of fractionated lasers, splitting the laser into thousands of tiny beams to induce zones of damage in between untreated areas, which promote the rapid regrowth of normal skin to re-epithelialize the treated areas. Dynamic thermal optimization is a technique that tunes the laser beam automatically to match skin heating, thus preventing under- and overtreatment.

Newer Developments

The Picosecond IR Laser (PIRL) is a novel laser concept which transfers energy to the water in the tissue, causing them to vaporize to produce tissue ablation, but avoiding mechanical or ionizing damage. Photochemical and photothermal effects are minimized by the targeted process. The scars are thinner and more collagen is regenerated during early wound healing. Better wound healing means shorter recovery times. Sonoillumination is a very new technique which changes skin properties using an ultrasound generator, coupled with an arrangement that ensures that the laser works only if it is in touch with the skin, protecting the eyes and the skin from unintended exposure.

Sources and Further Reading

Disclaimer: The views expressed here are those of the author expressed in their private capacity and do not necessarily represent the views of AZoM.com Limited T/A AZoNetwork the owner and operator of this website. This disclaimer forms part of the Terms and conditions of use of this website.

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

Citations

Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Thomas, Liji. (2019, May 13). How Lasers Are Used for Precise Surgical Work. AZoM. Retrieved on August 07, 2022 from https://www.azom.com/article.aspx?ArticleID=15914.

  • MLA

    Thomas, Liji. "How Lasers Are Used for Precise Surgical Work". AZoM. 07 August 2022. <https://www.azom.com/article.aspx?ArticleID=15914>.

  • Chicago

    Thomas, Liji. "How Lasers Are Used for Precise Surgical Work". AZoM. https://www.azom.com/article.aspx?ArticleID=15914. (accessed August 07, 2022).

  • Harvard

    Thomas, Liji. 2019. How Lasers Are Used for Precise Surgical Work. AZoM, viewed 07 August 2022, https://www.azom.com/article.aspx?ArticleID=15914.

Tell Us What You Think

Do you have a review, update or anything you would like to add to this article?

Leave your feedback
Your comment type
Submit