7 The principles and use of the neodymium-YAG laser in gynaecological surgery

Abstract

The neodymium-yttrium aluminium garnet (Nd-YAG) laser is one of the most recent surgical instruments to be exploited by gynaecologists. This review discusses the manner in which this laser interacts with tissue compared to other surgical lasers. The safety precautions necessary in using this laser are outlined in view of the potential risk of injury to theatre personnel. This is particularly important with respect to the eye. The most valuable application of the Nd-YAG laser to the gynaecologist is its use in ablating the endometrium in cases of menorrhagia. This technique is successful on account of the coagulating properties of this laser. The endometrium is destroyed to a depth sufficient to ablate the basal layer and bleeding is controlled by the coagulation of vessels. Much of the clinical part of this paper deals with this subject, detailing the choice of patients and the particular risks of the technique and discussing some of the problems. Other uses are outlined. Many of these are equally well treated by other and better-established methods. Undoubtedly the future will see many developments and more applications will become apparent.