Flexible CO2 Laser Fiber Research Articles

Optimal laser usage improves surgical efficiency in pediatric supraglottoplasty.

To compare patient specific and surgical efficiency outcomes in children undergoing supraglottoplasty (SGP) with flexible fiber CO2 laser in Ultrapulse mode versus cold steel at a tertiary care center. A single surgeon retrospective cohort study of pediatric patients with laryngomalacia undergoing SGP without concomitant or prior airway surgery. We reviewed perioperative complications, total hospital stay including intensive care admission, symptom resolution and the need for revision surgery. Surgical efficiency was measured as the mean total operative time and laryngeal suspension time. Among 63 patients, 32 cold steel SGPs were compared with 31 flexible fiber CO2 Ultrapulse laser SGPs. There was no statistical difference in the demographic profile. There was no statistical difference in need for intraoperative resuscitation (1 [3.0%] vs 0 [0%] cases) or perioperative intubation (4 [12.1%] vs 2 [6.3%] cases), mean total days in ICU (1.09 [0.51] vs 1.06 [0.44] [p=0.38]) or days hospitalized (1.73 [1.67] vs 1.62 [2.27] [p=0.42]), symptom resolution, need for revision surgery (2 [6.3%] vs 0 [0%] [p=0.49] patients) or mean operative time (29.0 [14.19] vs. 32.2 [22.71] [p=0.95] minutes). There was a statistically significant decreased time in laryngeal suspension in the laser group versus cold steel group (5.9 [1.80] vs 7.9 [2.19] [p=0.006] minutes). For pediatric SGPs, optimal flexible fiber CO2 laser usage can improve surgical efficiency in comparison to cold steel, with no differences in postoperative outcomes or complications. Both the flexible fiber CO2 laser and cold steel SGPs are safe and effective methods for treatment of laryngomalacia.

The evaluation of the usefulness of CO2 laser in microsurgical resection of brain tumors.

Background: Since its introduction to surgery, the CO2 laser has been used in the treatment of various neurosurgical pathologies as it combines cutting, vaporizing, and coagulating properties in one tool and has a safe penetration depth. In this case series of 29 patients, we present the evaluation of the usefulness of the closed system type – sealed tube surgical CO2 laser in the surgical removal of brain tumors.Methods: The Sharplan 40C model SurgiTouch, sealed tube type CO2 laser, was used in the resection of 29 brain tumors; 13 meningiomas, six metastases, nine gliomas, and one acoustic neuroma. The same senior surgeon (BT) assessed and classified the benefit provided by the CO2 laser in the resection of the neoplasms to considerable (Group 1), moderate (Group 2), and poor (Group 3).Results: Group 1 included 14 patients with 13 meningiomas and one acoustic neuroma, Group 2 included six patients, all of whom had metastases, and Group 3 included nine patients of which six had glioblastoma and three astrocytoma. No complications or technical problems occurred due to the use of the CO2 laser.Conclusion: The CO2 laser is a valuable complementary tool in brain tumor surgery displaying high efficacy and practicality in the resection of neoplasms which are fibrous and have hard consistency. It has high acquisition and maintenance cost and cannot replace the bipolar diathermy. The newest generation of flexible CO2 laser fiber provides more ergonomy and promises new perspectives of its neurosurgical use in the modern era.

Flexible Fiber CO2 Laser in Microsurgical Treatment of Intraventricular Tumors: Usefulness and Limitations

To assess usefulness and limitations of flexible fiber carbon dioxide (CO2) laser in the microsurgical treatment of intraventricular tumors. We reviewed a series of 9 patients treated with microsurgical resection of intraventricular tumors using a flexible fiber CO2 laser. The lesions involved the third ventricle (8) and the frontal horn of the right lateral ventricle (1). Histology revealed 6 craniopharyngiomas, 1 pituitary macroadenoma, 1 subependymoma, and 1 neurocytoma. In all cases, an interhemispheric transcallosal approach was performed. The laser was used during callosotomy, fornix column sectioning, tumor debulking, and to facilitate tumor dissection. We used a 5-tiered score system to assess laser's efficacy in each surgical step (approach, dissection, debulking): grade 1: laser was not at all helpful, grade 5: laser was extremely helpful. Limits of the instrument also are discussed. Gross total resection was achieved in 6 cases and subtotal resection in the remaining 3. Three patients had pulmonary complications treated without clinical sequelae. No laser-related complication was described. Mean utility score observed was 4.2 (range 3-5) during approach, 2.8 (range 2-4) during tumor dissection; and 3.3 (range 2-5) during tumor debulking. Main limits were low hemostatic effect and inefficiency versus calcified and highly vascularized tumors. The CO2 laser proved to be a useful and safe tool that could be used for intraventricular pathology; its design is suitable for narrow surgical corridors like interhemispheric fissure and foramen of Monro; its main utility is the ability to create precise and relatively bloodless cut (callosotomy, tumor debulking); low hemostatic effect is its main limit.

Flexible CO2 laser fiber: first look at the learning curve required in gynecological laparoscopy training.

The advent of flexible CO2 laser fiber to gynecology arena might represent a turning point in the use of laser energy on a large-scale basis in gynecological surgery. However, there might be some concerns regarding the degree of surgical skills required to use the flexible system. The purpose of our study is to evaluate whether flexible CO2 laser fiber is technically accessible. Fourteen residents in Obstetrics and Gynecology without surgical experience attending laparoscopic box training with both flexible CO2 laser fiber and traditional line-of-sight CO2 laser using Lumenis AcuPulse Duo CO2 laser (Lumenis, Yokne'am Illit, Israel) were prospectively enrolled. Participants were tested at sequential time points on specific surgical tasks and results obtained with the flexible CO2 laser fiber and the traditional line-of-sight CO2 laser were compared. Results were compared by means of paired t-test and a two-tailed P value <0.05 was considered significant. Mean grading at the beginning of training were similar between flexible fiber and line-of-sight CO2 laser. At the end of training, significant improvement in surgical skills was obtained for both techniques, with a statistically significant higher grading for flexible fiber CO2 laser compared to line-of-sight CO2 laser. Our study found that residents without surgical experience show better skills with the flexible CO2 laser fiber delivery system compared to the standard line-of-sight CO2 laser system after a two-month training period with gynecological laparoscopic box. According to our results, flexible CO2 laser fiber delivery system is technically accessible and holds a potential in gynecological surgery.

Flexible CO2 Laser Treatment for Subglottic Stenosis.

To assess the efficacy and safety of flexible fiber CO2 laser surgery for subglottic stenosis and to present retrospective experience of 14 patients treated with flexible fiber CO2 laser system. To determine the characteristics, management protocols, prognostic factors, and postoperative outcomes of the sample. Retrospective review of patients with subglottic stenosis undergoing flexible fiber CO2 laser surgery at the tertiary medical center. All demographic and clinical data were collected, radiologic and endoscopic evaluations were performed to assess the characteristics of stenosis. Myer-Cotton grading scale was used for classification of stenotic area. All patients have subglottic stenosis due to intubation-related causes and inappropriate tracheostomy procedure. The duration of intubation period ranged from 15 days to 4 years; 11 patients have grade III stenosis according to Myer-Cotton system and there was cricoid involvement in 2 patients. The mean follow-up period was 5.2 months and postoperative decannulation was achieved in 10 patients (71.4%). Subglottic stenosis is the difficult situation to manage minimal invasively. Flexible fiber CO2 laser surgery is safe and effective in the management of properly selected patients and can be used as a first option for patients.

The efficacy and safety of the flexible fiber CO2 laser delivery system in the endoscopic management of pediatric airway problems: Our long term experience

ObjectiveTo report the use of flexible fiber CO2 laser in the endoscopic management of pediatric airway cases. MethodsA retrospective review was conducted of patients who underwent CO2 laser-assisted airway procedures between September 2007 and January 2014 at a tertiary pediatric hospital. ResultsSixty-eight patients underwent 80 procedures utilizing flexible fiber CO2 laser. Procedures included supraglottoplasty (n = 32), laryngeal cleft repair (type I [n = 10], type II [n = 7], type III [n = 6]), suprastomal granuloma excision (n = 6), cordotomy (n = 4), laryngeal neurofibroma excision (n = 4), laryngeal granulomatous mass excision (n = 1), subglottic stenosis excision (n = 6), division of glottic web (n = 2), subglottic cyst excision (n = 1), and supraglottic biopsy (n = 1). Ages ranged from 8 days to 21 years (median 11 months). No intraoperative or postoperative complications related to the use of laser were noted. ConclusionsThe flexible fiber CO2 laser can be safely and effectively used to address a variety of pediatric airway lesions. Previously, the use of CO2 laser in minimally invasive airway surgery has been limited due to the articulating arm carrier, absence of a hand piece, and the direct line-of sight view required. The fiber allows the cutting beam to be directed at the site of the lesion and bypasses limitations posed by other laser systems.

Robotic single-site excision of ovarian endometrioma.

BackgroundConventional single-incision laparoscopic surgery has been successfully employed for treatment of ovarian endometriomas. However, this technique presents surgeons with formidable ergonomic challenges, that make its widespread adoption unlikely. Robotic assistance in single-incision laparoscopic surgery provides adequate instrument triangulation through a single fulcrum, while eliminating ergonomic challenges to the surgeon. The objective of this video is to describe a novel technique of laparoscopic excision and ablation of ovarian endometriomas with single-site robotic assistance. Footage from a single surgical case is shown in our video. The da Vinci Si surgical system with da Vinci Single-Site platform was utilized. A flexible CO2 laser fiber was employed as the main energy tool.To describe a technique of single-incision laparoscopic excision and ablation of endometriomas with robotic assistance.Footage from a single surgical case is shown in this video. The da Vinci Si surgical system with da Vinci Single-Site platform was utilized. A flexible CO2 laser fiber was employed as the main energy tool.ResultsOur technique achieved excellent surgical, clinical and cosmetic results, with complete excision and ablation of the endometriomas and no complications. The procedure was completed in day-surgery setting.ConclusionOur step-by-step video tutorial shows how the dedicated single incision laparoscopy technology for the da Vinci Si surgical system can be safely and effectively applied to the excision and ablation of ovarian endometriomas.Electronic supplementary materialThe online version of this article (doi:10.1186/s40738-015-0011-4) contains supplementary material, which is available to authorized users.

Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy

To compare the effectiveness and safety of a flexible carbon dioxide (CO2) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system. Retrospective cohort study. Level II-2 evidence. Reproductive surgery practice at an academic hospital. Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO2 laser (n = 85) or the ultrasonic scalpel (n = 151). Robot-assisted laparoscopic myomectomy employing either a flexible CO2 laser fiber or a robotic ultrasonic scalpel as the primary energy tool. Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups. Robot-assisted laparoscopic myomectomy with a flexible CO2 laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics.

Greater Surgical Precision of a Flexible Carbon Dioxide Laser Fiber Compared to Monopolar Electrosurgery in Porcine Myometrium

The objective of this experimental animal study was to compare the surgical precision of a flexible CO2 laser fiber with that of monopolar electrosurgery in porcine myometrium. The subjects were 6 live adult non-pregnant female pigs. Linear injury to the uterine horns was created using a flexible CO2 laser fiber at 5W, 10W, and 15W and with monopolar electrosurgery at 10W, 20W, 30W, and 40W in both cut and coagulation modes. Hysterectomy was then performed in the live animals. Cross-sections of the tissue were processed and stained using Masson trichrome to differentiate damaged from undamaged myometrium. Measurement means were compared using analysis of variance with Tukey honest significant difference correction; p <.05 indicated significance. Incision width of the laser at 5W and 10W was significantly less than both monopolar coagulation at all power settings and monopolar cut at 30W and 40W (all p <.01), at 5W was also significantly less than monopolar cut at 10W (p = .03), and at 15W was significantly less than monopolar coagulation at 40W (p = .001). Incision depth of the laser at 5W was significantly less than monopolar coagulation at 40W and laser at 15W (both p = .01), at 15W was significantly greater than monopolar coagulation at 10W and monopolar cut at 10, 20, and 30W (p ≤.01), and increased proportional to power for all 3 energy types. Collateral thermal damage width at all laser power settings was significantly less than at all monopolar coagulation power settings (p ≤.04) with the exception of the laser at 15W compared with monopolar coagulation at 10W (p = .30), and at all laser power settings was significantly less than at all monopolar coagulation power settings (p <.001). Collateral thermal damage depth of the laser at 5W and 10W was significantly less than monopolar cut at 30W (p ≤.002) and increased proportional to power in monopolar coagulation mode but remained constant with the laser. Incising efficiency of the laser at 5W was significantly greater than monopolar coagulation at 10W (p = .04), at 10W was significantly greater than at all monopolar power settings (p ≤.007) except cut at 40W (p = .29), and at 15W was significantly greater than that of every other energy type and power setting tested (p ≤.04). These findings support the hypothesis that CO2 laser energy delivered via a flexible fiber system would exhibit greater surgical precision than monopolar electrosurgery, in both cut and coagulation modes, as defined by 3 parameters: incising efficiency, changes in incision depth compared with width as power increases, and variability in the resulting incision measurements. Because increased thermal damage has been associated with delayed tissue necrosis and adhesion formation, these findings prompt the design of a comparative survival animal study to assess additional clinically relevant parameters.

CO2 Laser Myringoplasty

1) To describe a cost-effective, minimally invasive technique for treating tympanic membrane atelectasis, and 2) to present data on hearing improvement in patients receiving this as the basis for a future prospective study. Report of hearing and clinical outcome over a 4-year period. Tertiary center. Patients with tympanic membrane atelectasis and hearing loss. Valsalva, hydrodissection, or manual dissection reinflated the atelectatic segment under mask anesthesia. A CO2 laser hand-held fiber contracted the tympanic membrane. Then, myringotomy and pressure equalizing tube placement was performed. Status of the tympanic membrane, patency of the tubes, and pure tone average air-bone gap on preoperative, postoperative, and most recent audiograms. Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative air-bone gap was 15 dB, and this significantly improved to 7 dB (p < 0.001) postoperatively. Hearing improvement remained significant in the 17 patients with greater than 2 years' follow-up (7 dB, p = 0.007). Patients with effusion had worse preoperative air-bone gap (19 dB) compared with dry ears (12.5 dB, p = 0.02). However, postoperative and long-term air-bone gaps were not significantly different in the 2 groups (p = 0.3). Patients with myringostapediopexy that required or failed mechanical elevation did not have significant hearing improvement. Laser myringoplasty for treatment of tympanic membrane atelectasis using a hand-held flexible fiber CO2 laser is feasible and may improve hearing immediately and long term. It is not useful in severe adherent atelectasis. More studies are indicated to confirm its overall cost-effectiveness and competitiveness with traditional methods of managing atelectasis.

Flexible CO2 Laser Vs. Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy

Photonic and ultrasonic energy provide highly effective cutting and coagulation with a lesser extent of collateral thermal damage compared to electrosurgery. We aim to compare the effectiveness and safety of a flexible CO2 laser fiber to the ultrasonic scalpel when employed through a robotic surgical system.

Flexible CO2 laser vs. ultrasonic scalpel in robot-assisted laparoscopic myomectomy

Photonic and ultrasonic energy provide highly effective cutting and coagulation with a lesser extent of collateral thermal damage compared to electrosurgery. We aim to compare the effectiveness and safety of a flexible CO2 laser fiber to the ultrasonic scalpel when employed through a robotic surgical system.

Der Einsatz einer flexiblen CO2-Laser-Faser in der transoralen Roboter-assistierten Chirurgie (TORS)

Recently transoral robotic surgery has gained importance in the resection of head and neck tumors, especially in North America. The available resection tools are a fiber guided Tm:YAG-laser and a monopolar cautery, both causing wide coagulation and vaporization zones in healthy tissue. In order to improve the cutting properties we combined the system with a flexible CO2-laser fiber. 6 patients suffering from T1 and T2 oropharyngeal carcinomas were treated between July 2012 and September 2012. In a prospective study we analyzed the feasibility, cutting properties, speed of resection as well as hemostasis and compared those with the monopolar cautery and the Tm:YAG laser which were recently examined in a series of 17 patients. The application of a CO2-laser fiber with the da Vinci system was feasible and showed good cutting properties. Using a 15 watts energy level resulted in a favourable cutting depth and adequate hemostasis. In comparison to the monopolar cautery or the Tm:YAG laser, smaller coagulation and vaporization zones could be achieved. Cutting properties of the da Vinci system can be improved by using a flexible CO2-laser fiber. Further prospective evaluations will follow.

Minimally invasive approach to laryngeal cleft

Laryngeal cleft is a rare congenital anomaly that is recently being diagnosed with increased frequency. The objective of this report is to present a comprehensive description of endoscopic laser repair of a laryngeal cleft, using both the carbon dioxide (CO(2)) laser via a micromanipulator (Carl Zeiss Microimaging Inc., Thornwood, NY) and the flexible CO(2) laser fiber (OmniGuide, Inc.; Cambridge, MA), from both an anesthesia and surgical perspective. Laryngoscope, 2013.

KTP Versus CO2 Laser Fiber Stapedotomy for Primary Otosclerosis

To compare the 3-month postoperative hearing results after laser stapedotomy using a flexible potassium titanyl phosphate (KTP) or CO2 laser fiber in patients with primary otosclerosis. Prospective nonrandomized clinical study. Tertiary referral center, 862 stapedotomies were performed in 818 study patients between November 2006 and July 2011. Otosclerotic stapes fixation was treated with flexible KTP laser fiber in 410 patients (431 stapedotomies) and with flexible CO2 laser fiber in 408 patients (431 stapedotomies). Their preoperative and postoperative audiometric results were compared.Logistic regression analyses were performed to evaluate the main effect of laser fiber type and the effect after adjustment for independent predictors of a postoperative air-bone gap (ABG) 10 dB or lower. In the KTP laser group, the mean postoperative ABG was 4.3 dB compared with 3.1 dB in the CO2 group (difference, 1.1; 95% confidence interval, 0.4-1.9). In 90.4% of the patients in the KTP group, the postoperative ABG was 10 dB or lower, as compared with 96.5% in the CO2 group. The mean postoperative ABG at 4 KHz was 5.4 dB with KTP and 2.2 dB with CO2 (difference, 3.2; 95% confidence interval, 2.2-4.2). Sensorineural hearing loss was reported by 1 patient with KTP laser (0.3%) and by none with CO2 laser. "Type of laser" and "sex" were independent predictors of ABG 10 dB or lower. The chance to achieve a postoperative ABG 10 dB or lower for male subjects is 95%, when treated with CO2 laser and 85% when treated with KTP laser. For female subjects, these chances are 97% and 94%, respectively. The use of the CO2 laser fiber may be associated with better hearing results than the KTP laser fiber, regarding the ABG closure within 10 dB.

Clinical Thermal Effects of Flexible Fiber CO2 Laser

ObjectiveTo date no clinical investigations have reported on the coagulation effects of flexible fiber CO2 laser delivery to head and neck tissue, the results of which have a direct impact for the progression of transoral laser microsurgery. The objective of the present study was to investigate the histopathologic thermal effects of a flexible fiber CO2 laser delivery system.MethodA prospective histopathologic analysis of 15 consecutive transoral laser microsurgery specimens using the same CO2 fiber system were subjected to dedicated histopathologic analyses. Repeated coagulation depth measurements of 2 independent clinical pathologists were averaged. Specimens were stratified into lymphoid or epitheloid groups for further comparison.ResultsThe mean coagulation depth across all specimens was 81.53 um (SD, 38.73; range, 15.00‐360.34). Although the mean coagulation depth in lymphoid tissues (mean, 75.38 um; SD, 15.91) was elevated over the mean depth of epitheloid tissues (mean, 90.74 um; SD, 31.21), there was no significant difference (P =. 11).ConclusionWith an average coagulation depth of 81.53 um the flexible fiber thermal effect compares favorably to tissue effect of line‐of‐sight lasers. Epitheloid and lymphoid tissues displayed equivalent coagulative effects. To our knowledge, this is the first clinical description of flexible CO2 laser delivery thermal effects of tissues of the head and neck.

Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device.

We describe a novel surgical technique combining the use of a robotic surgical platform with a flexible CO2 laser in gynecologic surgery at a university-hospital-based reproductive medicine practice. Thirteen women with symptomatic uterine fibroids and/or adenomyosis, desiring uterine conservation, underwent robot-assisted laparoscopic myomectomy or focal adenomyomectomy with CO2 laser energy using a novel flexible delivery fiber (BeamPath GYN-L fiber, OmniGuide, Cambridge, MA, USA). On average, four myomas or areas of adenomyosis were removed with an average total specimen weight of 95g. The average operating time was 169min and the average estimated blood loss was 25mL. No perioperative complications were observed. Preliminary experience with robot-assisted minimally invasive gynecologic surgery utilizing a novel flexible CO2 laser fiber has comparable operative outcomes to those reported for conventional laparoscopic energy sources, and this technique appears safe. The minimal lateral thermal spread of photonic energy, combined with the enhanced precision allowed by a computer-based surgical platform, appears ideal for reproductive surgical applications.

Flexible fiber CO2 laser ablation of subglottic and tracheal stenosis

Flexible fiber CO2 laser ablation of subglottic and tracheal stenosis

Harmonic scalpel versus flexible CO2 laser for tongue resection: A histopathological analysis of thermal damage in human cadavers

BackgroundMonopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue.MethodsTwo fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison.ResultsThree tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003).ConclusionIn a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.

Harmonic Scalpel Versus Flexible Co2 Laser for Tongue Resection: A Histopathological Analysis of Thermal Damage in Human Cadavers

Background: Monopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue. Methods: Two fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison. Results: Three tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003). Conclusion: In a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.