Technical problems in the application of carbon dioxide laser in the treatment of genital intraepithelial neoplasia

Abstract

Recently there has been increasingly widespread application of carbon dioxide laser technology in the treatment of patients with genital intraepithelial neoplasia (1-3). While current configurations of operating microscopes and lasers are satisfactory for treating lesions of the cervix, they are unsatisfactory for the treatment of vaginal and vulvar lesions. For patients undergoing treatment for cervical disease, the area to be treated can be visualized within one binocular operative field, and the operation can be carried out without readjusting the microscope. Additionally, current focal lengths available at fixed magnifications are satisfactory for use in treating cervical lesions. For treatment of vaginal or vulvar intraepithelial disease, however, it is necessary to have appropriate hand-held devices which are free from the constraints of the fixed position of the operating microscope. Current counterbalanced and non-counterbalanced articulated arm devices and the associated hand pieces are still cumbersome and do not facilitate laser applications to these areas of the body. Technology for fiber transmission of carbon dioxide laser energy is still unrefined. The problems faced by the clinician in applying carbon dioxide laser technology in treating patients with genital intraepithelial neoplasia are reviewed and options for future modifications presented.Recently there has been increasingly widespread application of carbon dioxide laser technology in the treatment of patients with genital intraepithelial neoplasia (1-3). While current configurations of operating microscopes and lasers are satisfactory for treating lesions of the cervix, they are unsatisfactory for the treatment of vaginal and vulvar lesions. For patients undergoing treatment for cervical disease, the area to be treated can be visualized within one binocular operative field, and the operation can be carried out without readjusting the microscope. Additionally, current focal lengths available at fixed magnifications are satisfactory for use in treating cervical lesions. For treatment of vaginal or vulvar intraepithelial disease, however, it is necessary to have appropriate hand-held devices which are free from the constraints of the fixed position of the operating microscope. Current counterbalanced and non-counterbalanced articulated arm devices and the associated hand pieces are still cum...