CO2 Laser Surgery Research Articles

Essential principles of electrosurgery in operative laparoscopy

Summary The three principal parts of electrosurgical instrumentation are the generator and the active and passive electrodes; it is important that they be matched properly to obtain the desired tissue effects. The generator supplies the current flow, which is adjustable to enable the surgeon to deliver the correct energy levels for the condition at hand. The minimum effective voltage should be used to reduce the chance of “electron jumping,” or sparking to nearby unintended structures such as bowel and blood vessels. Fortunately, the physics of sparking (fulguration) preclude deep penetration, reducing the probability of a serious, deep injury. Several types of microelectrodes are available. Some are insulated, with only the tips exposed to decrease the chance of inadvertent damage to lateral tissue. Microelectrodes should be used for rapid vaporization of avascular planes, using the noncontact technique as described. Where coagulation effects are desired, for example, endometriosis implants on the broad ligament, electrodes of large diameter should be used to achieve superficial coagulation and to avoid deep penetration of current. Microelectrode surgery is equivalent to CO2 laser surgery used at superpulse or ultrapulse mode. 5, 6 Macroelectrosurgery with wide-tipped electrodes is similar to low power density CO2 laser surgery or fiber laser surgery. Tissue cutting must be precise and atraumatic to limit thermal and electrical damage to surrounding tissue. Electrosurgery provides the surgeon with a wide range of options: type of current, power level, unipolar and bipolar systems, and electrodes of various shapes and sizes. Also essential are proper equipment and basic understanding of, and meticulous adherence to, the related principles. Faulty or improper equipment, and lack of knowledge and careful attention on the part of the surgeon, may result in poor surgical outcomes and an increased possibility of unnecessary complications.

Comparison of CO2 Laser Surgery and Loop Electrosurgical Excision/ Fulguration Procedure for the Treatment of Vulvar Intraepithelial Neoplasia

Comparison of CO2 Laser Surgery and Loop Electrosurgical Excision/ Fulguration Procedure for the Treatment of Vulvar Intraepithelial Neoplasia

鼻過敏症に対するレーザー治療

Since 1982, we have performed the CO2 LASER turbinectomy for 1500 patients with perennial nasal allergy. We initially reported its methods and the short-term efficacy in 1986. The long-term efficacy and its mechanism will be discussed. Improvement was noted in 78% of the patients one month after laser surgery, and in 76% two years later. The longterm (2 years after the surgery) efficacy for nasal blockage, sneezing and nasal discharge are 72%, 70% and 67%, respectively. Laser surgery was more effective in younger than in older patients. Revepolization was performed in patients whose nasal symptoms had been alleviated after the initial laser surgery, resulting being of in 85% one month after the surgery in 78% 2 years after the surgery and in 64% 3 years after the revaporization. The long-term management of nasal symptoms can be possible by the revaporization with minimum cost and minimum time consuming. These results of the prolong effect of laser surgery for perennial nasal allergy were supported by the histological appearance of nasal mucosa: a layer of abundant fibrous tissue was evident even 5 years after CO2 LASER surgery. Also decreased content of ECP and decreased regional blood suggest that laser surgery eliminates the surface of nasal mucosa which is a site of allergic reaction.

Malignant Melanoma Treated by Laser Surgery and Radiation;

We present a case of oral malignant melanoma, which was treated by CO2laser surgery and radiation, and which has been controlled over seven years after the treatment.A 78-year-old female visited our hospital with a complaint of a black tumor in the upper molar region, September 20th, 1985. She noticed a swelling 2 months ago. At the first visit we observed a well defined pigmented mass, 20×30mm in size, in the left upper molar alveolar region, and several pigmented spots in the median part of the hard palate and the left buccal mucosa. We made a diagnosis of malignant melanoma and began a linac X-ray irradiation. When the radiation dose was 26Gy, we excised and vaporized the lesion including the bone of alveolar process and palate, pigmented spots of the palate and buccal mucosa using CO2 laser. Then we continued the radiotherapy and finished it total 60Gy. There is no recurrence or metastases over seven years after the treatment.

副鼻腔炎のレーザー，マクロライド併用療法

We devised a new combined therapy of CO2 LASER surgery and low-dose macrolide chemotherapy for chronic sinusitis. The effectiveness of this therapy was investigated in patients with chronic sinusitis and bilateral nasal polyps.Sixteen adult patients were first treated with 150mg of roxithromycin (RXM) per day for more than 3 months, and if nasal symptoms failed to improve further, LASER surgery was performed. Under local anesthesia, nasal polyps were resected and vaporized with 6-8W CO2LASER focused on the morbid mucous membrane of the middle meatus and/or the middle turbinate.The patients rated the severity of nasal symptoms before and after therapy according to a 4-point scale (0: none; 1: slight; 2: moderate; 3: severe). Nasal symptoms were 1) obstruction, 2) amount of discharge, 3) sense of smell. Nasal obstruction and amount of nasal discharge were relieved in all patients, and in 82% of the patients the sense of smell improved. The degree of opacification of the maxillary and the ethmoid sinuses on X-ray films improved in 71% and 64%, respectively. There were no major complications.We think that we should choose this therapy for chronic sinusitis before performing Caldwell-Luc operation or endoscopic sinus surgery.

Positive end-expiratory pressure lowers the risk of laser-induced polyvinylchloride tracheal-tube fires.

The possibility of ignition of polyvinylchloride (PVC) tracheal tubes by a CO2 laser is of concern in patients undergoing CO2 laser surgery of the airway. The authors analyzed the ignition of PVC tracheal tubes by a CO2 laser beam to determine what variables were involved, and then designed a study to determine how they affect the incidence of such fires. For the analysis, PVC tracheal tubes were enclosed in a clear plexiglass enclosure and a laser beam was focused on the tubes. The enclosure contained one of three different gas combinations. A high-speed camera photographed the tubes during the analysis and showed that tracheal tube perforation always preceded ignition in all three gas combinations. These results led to the hypothesis that intraluminal gauge pressure (IGP) may be an important variable, because it would affect the flow of O2 across the perforation. This hypothesis was tested by aiming a CO2 laser beam at PVC tracheal tubes and varying IGP in 0.25-cm H2O increments, from 0.25 to 28 cm H2O, while nitrogen or helium containing O2 at 40, 50, or 60% flowed through the tubes. To simulate the clinical effect of IGP on PVC tracheal tube ignition, we used a mechanical lung model connected to an anesthesia breathing circuit with a standing bellows ventilator in which 60% He and 40% O2 flowed through a PVC tracheal tube. Laser beam exposure was started at three different times during the respiratory cycle: at the start of inspiration, at the end of inspiration, or at the end of expiration. Also, for each condition, trials were made at baseline circuit pressure (2.5 cm H2O) and at 5.0 cm H2O by the addition of 2.5 cm H2O positive end-expiratory pressure (PEEP) applied to the circuit. The incidence of tracheal tube ignition decreased as IGP increased. The IGP at which ignition did not occur (which increased as O2 concentration increased) did not differ between N2 and He at 40% O2, but was twice as high with N2 as with He at O2 of 50% and 60%. Fires never occurred when PEEP was added to the system and, when PEEP was not added, always started during the last 2 s of end expiration (when airway pressure is lowest), regardless of when the laser beam was activated. It is recommended that, in addition to other safety practices, PEEP be added to the breathing circuit during CO2 laser operations on the airway in which PVC tracheal tubes or laser-resistant tracheal tubes with PVC components are used.

The effects of CO2 laser surgery on articular cartilage: C. Thomas Vangsness, Jr., Chad F. Smith, G. June Marshall, J.R. Sweeny, and W. E. Johansen. Los Angeles, California, U.S.A.

The effects of CO2 laser surgery on articular cartilage: C. Thomas Vangsness, Jr., Chad F. Smith, G. June Marshall, J.R. Sweeny, and W. E. Johansen. Los Angeles, California, U.S.A.

Twenty Years of CO2Laser Surgery: A Review and Update

Journal of Clinical Laser Medicine & SurgeryVol. 11, No. 2 Twenty Years of CO2 Laser Surgery: A Review and UpdateISAAC KAPLANISAAC KAPLANSearch for more papers by this authorPublished Online:28 Apr 2009https://doi.org/10.1089/clm.1993.11.57AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byTHE CO2 LASER AS A VERSATILE SURGICAL MODALITYLASER THERAPY, Vol. 16, No. 1Effects of heterogeneous absorption of laser radiation in biotissue ablation: Characterization of ablation of fat with a pulsed CO2 laserLasers in Surgery and Medicine, Vol. 21, No. 1 Volume 11Issue 2Apr 1993 To cite this article:ISAAC KAPLAN.Twenty Years of CO2 Laser Surgery: A Review and Update.Journal of Clinical Laser Medicine & Surgery.Apr 1993.57-60.http://doi.org/10.1089/clm.1993.11.57Published in Volume: 11 Issue 2: April 28, 2009PDF download

Use of the carbon dioxide laser in dermatologic surgery. A clinically relevant update for 1993.

The effective and safe use of the carbon dioxide (CO2) laser in the 1990s has been facilitated by technologic advances and widespread clinical use producing a better understanding of laser-tissue interactions, refinements in technique, and modifications of the list of indications. Safety guidelines have evolved from identification of complications. To discuss the basic principles and applications of CO2 laser surgery. Types of CO2 lasers and their applications are discussed. Today, use of the carbon dioxide laser simplifies many procedures, is reasonably safe, is effective for its intended usages, and is the preferred treatment of several cutaneous disorders.

鼻アレルギーに対するレーザー手術の検討 第１報： 効果の持続性の検討

The long-term results of CO2 laser surgery in 45 patients with perennial allergic rhinitis were reviewed, and compared with the short-term results in 365 patients. Improvement was noted in 78% of the patients one month after laser surgery, and in 76% two years later. Symptoms of nasal blockage, sneezing and nasal discharge did not seem to be different between the short-term and long-term treatment groups. Laser surgery was more effective in younger than in older patients. The results were supported by the histological appearance of the nasal mucosa: a layer of abundant fibrous tissue was evident even 5 years after CO2 laser surgery.

喉頭疾患に対するCO<SUB>2</SUB>レーザーの使用経験

We have been using CO2 laser surgery for laryngeal diseases since 1982. A total of 57 patients were treated with this procedure, including one patient with adult papilloma, four with intubation granuloma, 32 with vocal cord leukoplakia and 20 with glottic cancer. The results lead us to the following conclusions : 1. Laser treatment is indicated for benign diseases, such as papilloma, granuloma and vocal cord leukoplakia, and Ti cancer.2. Careful determination of the extent of lesion before surgery and long-term postoperative follow-up are essential in cases of histopathologically atypical disease and cancer.3. Laser treatment also appears to be useful from the standpoint of quality of life in elderly patients and in those patients to whom other therapeutic methods are not applicable.

CO2-laser treatment of recurrent glottic carcinoma.

The records of 23 patients treated by CO2-laser surgery for recurrent glottic carcinoma after radiotherapy were studied retrospectively to assess treatment results and complications. 15 patients (65%) were cured with one or more laser procedures. The remaining 8 underwent a total laryngectomy for a second or third recurrence. One patient (4%) died of disease. No major complications from CO2-laser surgery were encountered. It is concluded that CO2-laser surgery is a safe method of treatment of recurrent glottic carcinoma.

The treatment of epulis fissuratum of the oral cavity by CO 2 laser surgery.

A clinical study was conducted on a group of 20 patients who presented with epulis fissuratum caused by denture wearing. CO 2 laser surgery was used to treat these patients and the cases were followed up over a two-year period. The advantage of CO 2 laser surgery on oral tissues was evident by the good response to healing four weeks postoperatively and beyond. No sutures or packing of any kind were used and the wound was allowed to granulate. Re-epithelialization occurred in all patients within 14 days and was complete after about 4 weeks. The lack of wound contraction, scarring, and good re-epithelialization combined with precise tissue destruction make CO 2 laser surgery ideal for this procedure when compared with conventional surgical techniques. The advantage of using CO 2 laser surgery has been demonstrated clinically in the patients treated in this study.

Surgical Removal of Lower Eyelid Fat Using the Carbon Dioxide Laser

The CO2 laser, used for lower eyelid blepharoplasty, presented here according to David's technique, approaches the lower eyelid fat via the transconjunctival route. This technique avoids the possible sequelae associated with conventional surgical blepharoplasty, such as scarring and lower lid retraction. Postoperative recovery time is extremely rapid and associated with very little or no discomfort. CO2 laser surgery helps to prevent the risk of hemorrhage and infection, and keeps edema, when it occurs, to a minimum. The cosmetic results are excellent.

The Treatment of Benign Sebaceous Hyperplasia with the Topical Application of Bichloracetic Acid

Sebaceous hyperplasia is a benign lesion that occurs commonly on the face of older individuals. A variety of treatment options have been described, including oral isotretinoin, electrodesiccation, CO2 laser surgery, cryosurgery, and shave excision with curettage. Problems have been noted with these approaches. These techniques are more complex, less effective, require more time, or are more likely to scar than the procedure we describe. The treatment of sebaceous hyperplasia with bichloracetic acid is described with results presented after treatment of our first 20 patients.

CO2 Laser Surgery in Laryngeal Cancers: Three Year Results

The purpose of this paper is to evaluate the relapse-free survival and the overall survival at three years of 39 laryngeal cancers (10 T1 and 29 small recurrent carcinomas with mobile vocal cord) operated on by CO2 laser surgery at the Istituto Nazionale Tumori in Milan from 1982 to 1987. The 10 patients with T1 cancers had two local recurrences, whereas the 29 patients with recurrent carcinomas had 14 local recurrences. Local relapses occurred in 2/16 patients with cancer limited to the vocal cord and in 9/17 patients with glottic tumors extended to the anterior commissure or to the ventricular band or to the arytenoid. Supraglottic cancers recurred in 3/4 patients. The authors conclude that transoral laser surgery is an effective modality for treatment of T1 primary and small recurrent carcinomas of the larynx, when limited to the middle third of the vocal cord.

Why 70 Watts to Evaluate Metal Tapes for CO2 Laser Surgery?

Why 70 Watts to Evaluate Metal Tapes for CO2 Laser Surgery?

Why 70 Watts to Evaluate Metal Tapes for CO2 Laser Surgery?

Why 70 Watts to Evaluate Metal Tapes for CO2 Laser Surgery?

Minimally invasive therapy in otorhinolaryngology and head and neck surgery

SummaryMinimally invasive surgery in ENT means replacement of the traditional, partially destructive, approaches to the area with new surgical techniques using the natural openings of the body. Such techniques require special instruments, optical aids such as the endoscope and microscope, specialized knowledge of surgical anatomy, and particularly in the region of the paranasal sinuses, a new concept of mucous membrane treatment. CO2 laser surgery has become valuable for the treatment of inborn and acquired benign lesions of the upper aero-digestive tract in infants and adults. Laser surgery is especially useful for the management of vascularized tumours such as haemangiomas and papillomas and for stenosis since function can be preserved and tracheotomy avoided.In recent years great advances have been made in curative and palliative laser treatment of malignant tumours of the oral cavity, oropharynx, hypo-pharynx and the larynx. Early malignant lesions can be treated by micro-endoscopically controlled las...

光ファイバー炭酸ガスレーザーの使用経験

The application of optic fiber guide CO2 laser device to diseases of the nasal cavity, epipharynx and oral cavity is described. The probe of this device is 2.3mm in diameter and is made of argentum halide. The maximum output is 10 watts. It enables us to perform the CO2 laser surgery under optic fiber guide for the first time. It is expected to be applied more extensively because of its compactness and its ease of use even for outpatients.