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, and cauterize (seal) blood vessels to prevent excessive bleeding.

Precautions

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 and to describe the experience in performing the laser procedure the patient is considering.

Because some lasers can temporarily or permanently discolor the skin, 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.

Description

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.

Types of lasers

There are three types of lasers most often used in medical treatment. The color of the light beam (within the laser) is directly related to the type of surgery performed (specifically, the color of the tissue involved). The carbon dioxide (CO₂) laser is primarily a surgical tool. This device converts light energy to heat, which is strong enough to minimize bleeding while it cuts through or vaporizes tissue). The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is 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). The argon 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.

Laser applications

Sometimes lasers are described as scalpels of light. Today, lasers are used alone or with conventional surgical instruments in a diverse array of procedures that, improve appearance, relieve pain, restore function, and 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), and 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, 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.

Advantages of laser surgery

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.

Disadvantages of laser surgery

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. Imprecisely aimed lasers can burn or destroy healthy tissue.

The American Society for Laser Medicine and Surgery, Inc. urges that: (1) All operative areas should be equipped with oxygen and other drugs and equipment required for cardiopulmonary resuscitation (CPR). (2) Non-physicians performing laser procedures should be properly trained, licensed, and insured. (3) A qualified and experienced supervising physician should be able to respond to and manage unanticipated events or other emergencies within five minutes of the time they occur. (4) Emergency transportation to a hospital or other acute-care facility should be available whenever laser surgery is performed in a non-hospital setting.

Preparation

Because laser surgery is used to treat so many dissimilar conditions, the patient should ask his physician for detailed instructions about how to prepare for a specific procedure. Diet, activities, and medications may not have to be limited prior to surgery, but some procedures require a physical examination and a medical history that: determines the patient’s general health and current medical status; describes how the patient has responded to other illnesses, hospital stays, and diagnostic or therapeutic procedures; and clarifies what the patient expects the outcome of the procedure to be.

Aftercare

Most laser surgeries can be performed on an outpatient basis, and patients are usually permitted to leave the hospital or medical office when their vital signs have stabilized. A patient who has been sedated should not be discharged: until he/she has recovered from the anesthesia and knows who and where he/she is; and unless the patient is accompanied by a responsible adult.

The doctor may prescribe analgesic (pain-relieving) medication, and should provide easy-to-understand written instructions that describe how the patient’s recovery should progress and what to do in case complications or emergency arise.

Risks

Like traditional surgery, laser surgery can be complicated by: hemorrhage, infection, or perforation (piercing) of an organ or tissue.

Laser surgery can also involve risks that are not associated with traditional surgical procedures. Being careless or not practicing safe surgical techniques can severely burn the patient’s lungs or even cause them to explode. Patients must wear protective eye shields while undergoing laser surgery on any part of the face near the eyes or eyelids, and the U.S. Food and Drug Administration (FDA) has said that both doctors and patients must use special protective eyewear whenever a CO₂ laser is used.

Normal results

The nature and severity of the problem, the skill of the surgeon performing the procedure, and the patient’s general health and realistic expectations are among the factors that influence the outcome of laser surgery.

Successful procedures can enable patients to: feel better; look younger; and enjoy longer, fuller, more active lives.

A patient who is considering any kind of laser surgery should ask his doctor to provide detailed information about what the outcome of the surgery is expected to be, what the recovery process will

KEY TERMS

Argon —A colorless, odorless gas.

Astigmatism —Irregular curvature of the cornea causing distorted images.

Canker sore —A blister-like sore on the inside of the mouth that can be painful but is not serious.

Carbon dioxide —A heavy, colorless gas that dissolves in water.

Cardiopulmonary resuscitation —An emergency procedure used to restore circulation and prevent brain death to a person who has collapsed, is unconscious, is not breathing, and has no pulse.

Cauterize —To use heat or chemicals to stop bleeding, prevent the spread of infection, or destroy tissue.

Cornea —The outer, transparent lens that covers the pupil of the eye and admits light.

Endometriosis —An often painful gynecologic condition in which endometrial tissue migrates from the inside of the uterus to other organs inside and beyond the abdominal cavity.

Glaucoma —A disease of the eye in which increased pressure within the eyeball can cause gradual loss of vision.

Invasive surgery —A form of surgery that involves making an incision in the patient’s body and inserting instruments or other medical devices into it.

Nearsightedness —A condition in which one or both eyes cannot focus normally, causing objects at a distance to appear blurred and indistinct. Also called myopia.

Ovarian cyst —A benign or malignant growth on an ovary. An ovarian cyst can disappear without treatment or become extremely painful and have to be surgically removed.

Vaporize —To dissolve solid material or convert it into smoke or gas.

Varicose veins —Swollen, twisted veins, usually occurring in the legs, that occur more often in women than in men.

involve, and how long it will probably be before he/she regains a normal appearance and can resume his/her normal activities.

Abnormal results

A person who is considering any type of laser surgery should ask his/her doctor to provide specific and detailed information about what could go wrong during the procedure and what the negative impact on the patient’s health or appearance might be.

Lighter or darker skin may appear, for example, when a laser is used to remove Sun damage or age spots from an olive-skinned or dark-skinned individual. This abnormal pigmentation may or may not disappear in time.

Scarring or rupturing of the cornea is uncommon, but laser surgery on one or both eyes can: increase sensitivity to light or glare; reduce night vision; permanently cloud vision; or cause sharpness of vision to decline throughout the day.

Signs of infection following laser surgery include: burning, crusting of the skin, itching, pain, scarring, and severe redness.

Laser beams can burn or destroy healthy tissue, cause injuries that are painful and sometimes permanent, and actually compound problems they are supposed to solve. Errors or inaccuracies in laser surgery can worsen a patient’s vision, for example, and lasers can scar and even change the skin color of some patients. Laser surgery is sometimes performed under general anesthesia. The risks of general anesthesia should be discussed with the anesthesiologist before the surgical procedure.

The amount of convalescence and recovery time will vary depending on the pre-existing health and condition of the patient and the type of surgery performed. The time necessary for convalescence and recovery can be generally determined based on these specific factors, and should be discussed with the medical team before the surgery.