New Developments in CO 2 Laser Stapedotomy

Abstract

Summary The idea of applying the CO2 laser as a precise and contact-free instrument in middle-ear surgery and especially in stapes surgery is based on the desire to reduce the complication rate of these interventions by further optimizing the surgical techniques. Today, using high-precision micromanipulators, the laser beam can be focused to a spot diameter of 180 μm. New application modes combined with scanner systems enable an exact adjustment to the demands of stapes surgery, thus permitting the finest microsurgical work. “One shot” stapedotomy can be achieved by microprocessor-controlled movement of the focused laser beam over a defined area (diameter: 0.5 to 0.7 mm) by rotating mirrors. On the basis of experimental data, effective and safe parameters were determined with the CO2 laser and applied in the clinical routine. Compared to conventional techniques the CO2 laser irradiation enables precise and contact-free procedures on middle ear structures. The risk of chain luxation, particularly footplate mobilization (floating footplate) or damage to the adjacent middle and inner ear structures is practically impossible with the limitation of the energy parameters used here.