Laser Surgery

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Laser surgery

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

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
describe his 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

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.

Laser applications

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
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.

The American Society for Laser Medicine and Surgery, Inc. urges that:

All operative areas should be equipped with oxygen and other drugs and equipment required for cardiopulmonary resuscitation (CPR).
Non-physicians performing laser procedures should be properly trained, licensed, and insured
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.
Emergency transportation to a hospital or other acutecare facility should be available whenever laser surgery is performed in a non-hospital setting.

Imprecisely aimed lasers can burn or destroy healthy tissue.

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
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 has recovered from the anesthesia and knows who and where he is
unless he 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
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 United States Food and Drug Administration (FDA) has said that both doctors and patients must use special protective eyewear whenever a CO2 laser is used.

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.

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

Abnormal results

A person who is considering any type of laser surgery should ask his 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
severe redness
swelling

Resources

books

Carlson, Karen J., et al. The Harvard Guide to Women'sHealth. Cambridge, Massachusetts: Harvard University Press, 1996.

Keller, Gregory, et al. Lasers in Aesthetic Surgery. New York: Thieme Medical Pub., 2001)

periodicals

Alster, Tina S. "Update on Dermatologic Laser Surgery: New Trends for 2002." Cosmetic Dermatology 15, no. 2 (2002): 33-37.

Kronberger, C. "The Veterinary Technician's Role In Laser Surgery." Veterinary Clinics of North America 32, no. 3 (2002): 723-735.

"Laser Procedures for Nearsightedness." FDA Consumer (January-February 1996): 2.

"Laser Resurfacing Slows the Hands of Time." Harvard HealthLetter (August 1996): 4-5.

"Lasers—Hope or Hype?" American Health (June 1994): 68-72, 103.

"Lasers." Mayo Clinic Health Letter (July 1994): 1-3.

"Lasers for Skin Surgery." Harvard Women's Health Watch (March 1997): 2-3.

"The Light Fantastic." Helix (Winter 1989): 3-9.

"New Cancer Therapies That Ease Pain, Extend Life." CancerSmart (June 1997): 8-10.

"New Laser Surgery for Angina." HealthNews (May 6, 1997): 3-4.

"Saving Face." Essence (August 1997): 24, 26, 28.

"What a Laser Can and Cannot Do." San Jose Mercury News (February 1994): 22, 24.

Maureen Haggerty

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.