Laser-assisted Surgery Research Articles

Endoscopic CO2 laser-assisted surgery for cricopharyngeal dysfunction.

Endoscopic cricopharyngeal myotomy was performed on 29 patients with dysphagia from failed relaxation of the cricopharyngeal muscle. The patient outcome was retrospectively evaluated. The average age at the time of treatment was 62 years (range: 38-81 years), and the mean follow-up was 18 months (range:1-36 months). The procedure was the first to be performed in all except four of the patients. Preoperative and postoperative assessments included videofluoroscopic and flexible endoscopic evaluations of the swallow as well as patients' subjective ratings for dysphagia and aspiration. These investigations and self-assessments were rated from 0 (poor or abnormal) to 4 (good or normal). Surgical procedures were performed under general anesthesia. Using the diverticuloscope, the posterior portion of the cricopharyngeal muscle was exposed and CO2 laser sectioned. The wound was then covered with fibrin glue. Patients were parenterally fed for 72 h. Postoperative videofluoroscopy showed the absence of leakage, and all patients resumed oral intake on day 2. The median self-rating score improved from 1 to 4 for dysphagia and from 3 to 4 for aspiration. The outcome of the flexible endoscopic evaluation of swallow improved from 2 to 4 and videofluoroscopy improved from 2 to 4. No surgical complication occurred. Endoscopic CO2 laser-assisted surgery is an effective and safe alternative for the treatment of cricopharyngeal dysmotility.

KTP-532 laser-assisted endoscopic nasal sinus surgery.

The present study is meant to give an overview of the application of KTP lasers in endoscopic sinus surgery and to give an account of the experience gained in the course of 24 operations. Laser-assisted FESS was performed in 24 patients (13 on the right side and 11 on the left side). Sixteen men and eight women were treated for chronic maxillary sinusitis. Diagnostic criteria of chronic maxillary sinusitis included at least 3 months history of intermittent or persistent facial pain, intermittent or persistent fever, tenderness or headache over the areas of the maxillary, ethmoid or frontal sinuses, purulent discharge from nasal passages or nasopharynx, and radiographic evidence of opacification on CT scans. Traditional FESS surgery was performed on the one side and KTP laser-assisted surgery on the other side. CT was performed in each case. The operations were carried out under local anaesthesia. The KTP laser was delivered via an optical fibre (0.6 mm) and was used for bone ablation, incision, vaporization and coagulation. Patient symptoms were recorded using a self-administered questionnaire preoperatively, and postoperatively on weeks 1, 4, 12 and 24. Blood loss on the laser-assisted operations' side was minimal. The improvement of the symptoms (pain, sensation of fullness, discharge) during weeks 1 and 4 proved to be significant (P < 0.05) in the case of both techniques. The cumulated average of the point scores on the laser-assisted side was higher: especially postoperative week 1. Of the parameters assessed in the course of healing, oedema prevailed on the laser-assisted side, while crusting was characteristic in the traditional operation site. We conclude that laser-assisted FESS surgery is as effective as traditional endonasal sinus surgery. Its advantage is that it offers excellent haemostasis, as the use of 'star pulse' mode allows accurate bone work. No complications were observed. The disadvantage of the laser-assisted procedure is that the instrument is expensive and it is time consuming.

CO 2 Laser in Rhinology

Summary During the last decade, laser therapy developed to be one of the most important new therapeutical approaches in the field of otorhinolaryngolgy. Specifically in nasal applications, laser-assisted surgery offers many advantages including precision vaporization or incision associated with decreased edema, decreased postoperative pain, improved hemostasis, decreased direct tissue contact and instrumentation as well as avoid the need for nasal packing. Different laser systems have been implemented for nasal application. The greatest experience by far could be gathered with the argon laser. In addition, there have been reports of the successful application of CO2 laser, KTP laser, Ho:YAG laser, magnet laser, diode laser and Nd:YAG laser. Based on the limited depth of each laser system, each system is potentially useful for treating a special type of nasal disease including nasal airway obstruction, polyposis or benign lesions of the nasal cavity. This article focusses on main indications for the CO2 laser in rhinologic surgery.

Laser applications in oculoplastic surgery and their postoperative complications.

Laser surgery for oculoplastic or dermatological indications--whether incisional work, removal of pigmented or vascular lesions, removal of hair, or resurfacing--necessitates that the practitioner have appropriate training in and understanding of not only the techniques but also of their advantages and disadvantages. Understanding laser safety and how to handle complications is critical to appropriate management of laser-assisted surgery. Long-term results are limited at this time, but current information regarding the use of lasers in aesthetic oculoplastic surgery appears promising. New approaches to such operations include combining more than one type of laser or combining traditional cutting blades and lasers in an effort to reduce side effects and improve outcome.

The use of lasers in operative orthopedics – an update

In laser-assisted arthroscopic knee surgery, clinical outcome and experimental results are quite different. After laser treatment of local chondromalacia, large cartilage lesions with less tendency towards repair were more often seen than after conventional arthroscopic treatment. Therefore, laser treatment of chondromalacia cannot be recommended. Compared with conventional meniscectomy, laser-assisted meniscal surgery has some advantages, but there is also some risk of inducing gonarthrosis. Some studies show a good hemostatic effect of the laser and the feasibility of precise tissue cutting. On the other hand, laser treatment causes alteration of the tissue. The meniscal tissue becomes stiffer, which may promote the manifestation of gonarthrosis. Percutaneous laser disc decompression has been in successful clinical use since 1986 in the treatment of intervertebral disc prolapses. Studies of multiple orthopedic departments worldwide show a success rate of 75%. To guarantee the success the indications must be observed. The use of lasers in the arthroscopic treatment of outlet impingement syndrome have some advantages, too. The outcome is better than that of other arthroscopic techniques and there are fewer complications because of the hemostatic effect and the improved vision. Laser-assisted capsular shrinkage combined with arthroscopic labrum reattachment allows conventional laser use. Capsular shrinkage can be achieved with low-level laser energy. If this treatment is not successful, other operative techniques can be performed without restrictions.

Lasers in oculoplastic surgery.

Applications of laser-assisted surgery in oculoplastics are varied because the enormous scope of the specialty overlaps with ear, nose and throat, dermatology, plastic surgery, and ophthalmology, for example. All of these specialties have applications for lasers that in one fashion or another find their way into our armamentarium. In this article we present the last year's advances in laser applications in oculoplastics. By far, endonasal dacryocystorhinostomies are the most controversial and interest producing. Several articles address different approaches and conclusions. No final determination is available yet as to the effectiveness and ultimate success of this procedure. Dermatologic surgery for lesion removal and for cosmetic surgery also features in this year's review. The use of lasers for tattoo removal was reported in detail in a superb article. Overall there were no major breakthroughs in laser surgery, however, several well-thought-out articles have added to our understanding of this surgical modality.

Aggressive pulmonary metastasectomy for soft tissue sarcomas.

To evaluate the efficacy of aggressive pulmonary metastasectomy for treating soft tissue sarcomas, the clinical data on the surgical management of 23 patients with extensive pulmonary metastases from soft tissue sarcomas were reviewed. Between January 1973 and April 1991, 9 male patients and 14 female patients were treated. Their ages ranged from 13-68 years (median, 42 years). Twenty-one patients (91%) had bilateral and multiple metastases, and two patients had solitary metastasis. The number of resected metastatic nodules ranged from 1-110 (mean, 30.5). As an initial surgical approach, median sternotomy was used on 18 patients and lateral thoracotomy on 5 patients. Eleven patients underwent two or more explorations for recurrent metastases using lateral thoracotomy. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was adopted in 10 patients since 1986. The actuarial 2-year and 5-year survival rates after the first pulmonary resection were 49.7% and 24.8%, respectively. Histologic type (alveolar soft part sarcoma versus synovial sarcoma, P < 0.025), histologic grade (G1 and G2 versus G3, P < 0.01), and metastatic localization (subpleural versus extrapleural, P < 0.005) were the most significant prognostic factors for aggressive pulmonary metastasectomy of soft tissue sarcomas. Application of laser surgery, absence of local recurrences, and absence of extrapulmonary metastases before pulmonary resection also correlated with better prognosis with borderline significance. Aggressive pulmonary metastasectomy for soft tissue sarcomas is a recommended procedure, even in the case of extensive metastases. The combination of median sternotomy and Nd:YAG laser-assisted surgery is a useful technique, especially in bilateral multiple pulmonary metastases.