The expanding role of the laser in gynecology

Abstract

The first gynecological application of the carbon dioxide laser was reported in 1973, when it was used to treat erosions of the cervix. Prior to this, cervical lesions had been treated by electrocautery, cryosurgery, topical chemotherapy and surgical excision. Soon, reports on the use of the carbon dioxide laser to vaporize cervical intraepithelial neoplasia (CIN) appeared, with success rates of only 63%. Early series did not vaporize to sufficient depth or use high power densities and frequently only removed the lesion itself, instead of the entire at risk area. Anderson and Hartley pointed out that cervical intraepithelial neoplasia occurred in the cervical glands or crypts and extended into the stroma 5mm. or less in 99.7 per cent of the cases. Therefore, it was necessary to vaporize at least 5 mm. to obtain satisfactory cure rates. By using the operating microscope and power densities greater than 1000 watts/cm2, vaporization of cervical tissue occurred quicker and with less thermal injury; and by destroying the entire transformation zone, the success rate was improved. Involvement of the endocervical canal by CIN resulted in a lower cure rate and advised against using vaporization in these instances.The first gynecological application of the carbon dioxide laser was reported in 1973, when it was used to treat erosions of the cervix. Prior to this, cervical lesions had been treated by electrocautery, cryosurgery, topical chemotherapy and surgical excision. Soon, reports on the use of the carbon dioxide laser to vaporize cervical intraepithelial neoplasia (CIN) appeared, with success rates of only 63%. Early series did not vaporize to sufficient depth or use high power densities and frequently only removed the lesion itself, instead of the entire at risk area. Anderson and Hartley pointed out that cervical intraepithelial neoplasia occurred in the cervical glands or crypts and extended into the stroma 5mm. or less in 99.7 per cent of the cases. Therefore, it was necessary to vaporize at least 5 mm. to obtain satisfactory cure rates. By using the operating microscope and power densities greater than 1000 watts/cm2, vaporization of cervical tissue occurred quicker and with less thermal injury; and by des...