Clinical use of carbon dioxide (CO2) laser in microsurgical vasovasostomy

Herein are reported the first 4 clinical cases of carbon dioxide (CO2) laser microsurgical vasovasostomy. Fusion-coagulation of the vas wall was successfully accomplished, as demonstrated by adequate postoperative sperm counts and a 50 per cent pregnancy rate. A significant reduction in the total operative time was achieved as compared with the conventional microsurgical suture technique, corroborating the ability of the CO2 laser to simplify this technique while producing a sperm-tight anastomosis.     

Carbon dioxide (CO2) laser therapy for conjunctival lymphangioma

Lymphangiomatous tissue involving the ocular adnexa may be difficult to manage because this highly vascular, unencapsulated tissue intermingles freely with normal adnexal structures. Hemostasis is difficult to obtain, and important ocular and periocular structures are damaged easily. We have successfully treated two individuals who had extensive conjunctival involvement of their lymphangioma with the carbon dioxide (CO2) laser. The CO2 laser permits a precise form of treatment with the ultimate form of hemostasis (tissue vaporization), resulting in minimal trauma, edema, and scarring, and thus offers a safe alternative to surgical excision of these lesions.     

A versatile dual-channel carbon dioxide (CO2) insufflator for various CO2 applications

Background Carbon dioxide (CO₂), with its rapid absorptive nature, has been proven superior to atmospheric air as an insufflating agent in various clinical settings. However, CO₂ insufflation has not gained wide clinical acceptance, mainly because there has been no suitable feeding system. The authors therefore have developed a versatile “dual-channel” CO₂ insufflator that facilitates wider use of CO₂. The objectives of this study were to introduce the authors’ prototype insufflator, to evaluate its safety and performance, and to validate CO₂ application using the prototype. Methods The prototype insufflator provides one CO₂ inlet connected to a regular CO₂ gas cylinder and two CO₂ outlets positioned on the front and back of the device, respectively. The CO₂ gas fed from the cylinder is pressure-regulated and divided into two independent conduits inside the device. The front outlet feeds CO₂ gas for pneumoperitoneum at an electronically controlled pressure and flow rate. The back channel supplies CO₂ gas at a fixed flow rate, allowing manual control of insufflation for various purposes. The device was evaluated with canine models. Results The prototype was safe and performed well. The CO₂ application (colonoscopy in this series) using the back channel was feasible while intact CO₂ pneumoperitoneum was simultaneously maintained via the front channel. There were no device malfunctions. The serial abdominal x-rays indicated that intraluminal CO₂ insufflation such as that used for CO₂ colonoscopy caused less residual intestinal gas than conventional air insufflation. Conclusions The dual-channel CO₂ insufflator enabled two different modes of CO₂ insufflation at the same time from a single CO₂ cylinder. The authors are now improving the prototype to allow safer and wider usage of CO₂ in the operating room.     

Microvascular anastomosis with a low-output carbon dioxide (CO2) laser. II. Histopathological features

A low-output CO2 laser was applied for microvascular anastomosis. The healing process of the vessel wall was examined histopathologically using light and scanning electron microscopes, and compared with that following conventional suture anastomosis. A power level of 21-40 mW and an exposure time of 5-15 sec were used. Under these conditions the laser beam reached the adventitia and media but not the intima. This made it possible to perform microvascular anastomosis without causing damage to the intima. Inflammatory reactions in the vessel wall were milder and endothelialization of the lumen surface occurred somewhat earlier with the laser technique than with the conventional technique of manual suture anastomosis.     

Microvascular anastomosis using carbon dioxide (CO2) laser: evaluation by SEM after corrosion cast

In order to compare the carbon dioxide laser-assisted microvascular anastomosis (CO2 LAMA) with conventional microvascular sutured anastomosis (CMSA), 40 microarterial anastomoses were performed in Wistar albino rats. At different time intervals from zero to four weeks after the procedure, the anastomoses were examined under the scanning electron microscope (SEM) after resin corrosion cast (Mercox). CO2 LAMA was easier and less time-consuming than CMSA, with the same patency rate. Healing of the lumen surface was similar in both procedures, suggesting that CO2 LAMA can be reliably used in microvascular anastomosis.     

Granular cell abrikossoff tumours of the larynx and tongue treated with the carbon dioxide (CO2) laser

Seven cases of granular cell Abrikossoff tumours of the larynx and tongue are reported: four in the tongue and three in the larynx. All of these tumours were removed with the carbon dioxide (CO₂) laser. The anatomical site of the origin and clinical features of granular cell tumours (GCT) are not specific. Histological, light microscopic, electron microscopic (EM) and immunohistochemical studies are required for diagnosis. The histogenesis and cellular derivation of GCTs is still controversial. The biological potential and lack of cellular atypia define a benign process. However, it is important to take into account that these tumours have ill-defined borders without a capsule. Radiation therapy has proved ineffective in the past. Surgical excision with a wide margin is required. Because of numerous advantages, for example, no bleeding, no oedema, minimal pain and quick recovery, CO₂ laser removal is the treatment of choice. The authors have not seen any recurrence or complications.     

CO2气体灌注内镜甲状腺手术的研究

目的 观察内镜甲状腺手术CO2充气对机体病理生理的影响,探讨CO2充气内镜甲状腺手术临床应用的可行性.方法 通过动物颈部灌注CO2气体压力及其内镜甲状腺切除术实验,检测动物在术前、术中30、60 min和手术结束各时段心率(HR)、呼吸频率(BR)、PH、PaO2、PaCO2和BE.依据CO2气体灌注内镜甲状腺手术的基础,分析经前胸壁入路内镜甲状腺切除术31例临床资料.结果 应用6mmHg CO2(1 mmHg=0.133 kPa)充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE在手术过程中无明显变化.应用12 mmHg CO2充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE变化差异均有统计学意义(P<0.01).临床31例患者均顺利完成手术,其中行甲状腺部分切除加例,甲状腺次全切11例.平均手术时间113 min,平均术中出血量6 ml,术后平均引流时间2.83 d,术后平均住院时间4 d.术后无喉上、喉返神经损伤及甲状旁腺损伤,无高碳酸血症出现.所有病例随访1～10个月均无不适.结论 严格掌握手术适应证及禁忌证,掌握其并发症的特点和防治措施,完善相应的围手术期处置,临床上将CO2气体灌注压力控制在4～6 mmHg,进行内镜甲状腺切除术安全可行,具有良好的微创、美观效果.     

CO2气体灌注内镜甲状腺手术的研究

目的 观察内镜甲状腺手术CO2充气对机体病理生理的影响,探讨CO2充气内镜甲状腺手术临床应用的可行性.方法 通过动物颈部灌注CO2气体压力及其内镜甲状腺切除术实验,检测动物在术前、术中30、60 min和手术结束各时段心率(HR)、呼吸频率(BR)、PH、PaO2、PaCO2和BE.依据CO2气体灌注内镜甲状腺手术的基础,分析经前胸壁入路内镜甲状腺切除术31例临床资料.结果 应用6mmHg CO2(1 mmHg=0.133 kPa)充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE在手术过程中无明显变化.应用12 mmHg CO2充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE变化差异均有统计学意义(P<0.01).临床31例患者均顺利完成手术,其中行甲状腺部分切除加例,甲状腺次全切11例.平均手术时间113 min,平均术中出血量6 ml,术后平均引流时间2.83 d,术后平均住院时间4 d.术后无喉上、喉返神经损伤及甲状旁腺损伤,无高碳酸血症出现.所有病例随访1～10个月均无不适.结论 严格掌握手术适应证及禁忌证,掌握其并发症的特点和防治措施,完善相应的围手术期处置,临床上将CO2气体灌注压力控制在4～6 mmHg,进行内镜甲状腺切除术安全可行,具有良好的微创、美观效果.     

CO2气体灌注内镜甲状腺手术的研究

目的 观察内镜甲状腺手术CO2充气对机体病理生理的影响,探讨CO2充气内镜甲状腺手术临床应用的可行性.方法 通过动物颈部灌注CO2气体压力及其内镜甲状腺切除术实验,检测动物在术前、术中30、60 min和手术结束各时段心率(HR)、呼吸频率(BR)、PH、PaO2、PaCO2和BE.依据CO2气体灌注内镜甲状腺手术的基础,分析经前胸壁入路内镜甲状腺切除术31例临床资料.结果 应用6mmHg CO2(1 mmHg=0.133 kPa)充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE在手术过程中无明显变化.应用12 mmHg CO2充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE变化差异均有统计学意义(P<0.01).临床31例患者均顺利完成手术,其中行甲状腺部分切除加例,甲状腺次全切11例.平均手术时间113 min,平均术中出血量6 ml,术后平均引流时间2.83 d,术后平均住院时间4 d.术后无喉上、喉返神经损伤及甲状旁腺损伤,无高碳酸血症出现.所有病例随访1～10个月均无不适.结论 严格掌握手术适应证及禁忌证,掌握其并发症的特点和防治措施,完善相应的围手术期处置,临床上将CO2气体灌注压力控制在4～6 mmHg,进行内镜甲状腺切除术安全可行,具有良好的微创、美观效果.     

Experimental irradiation of femoral arteries by carbon dioxide (CO2) laser: morphologic changes under transmission electron microscope (T.E.M.) examination

In order to study the morphologic changes after CO2 laser irradiation, 42 rat femoral arteries were irradiated under various conditions at different time intervals from zero to three weeks. The arteries were examined under transmission electron microscope (T.E.M.), and 30 mW power and 0.3 to 0.5 mm/sec velocity were considered to be the most suitable for a CO2 anastomosis of small femoral arteries.     

Initial experience with combined interferon-alpha 2B and carbon dioxide laser for the treatment of condylomata acuminata.

The incidence of condylomata acuminata, a common sexually transmitted disease caused by certain types of human papillomaviruses, is increasing rapidly and treatment regimens presently are not consistently effective. One of the more popular and effective modes of treatment has been laser therapy. Because of the relatively high recurrence rate of condylomata acuminata with laser treatment alone and because laser treatment in some patients with confluent acetowhite lesions would render cosmetically unacceptable results in the entire area were treated, we believed that it was reasonable to use intralesional pretreatment. We present our preliminary data on 14 consecutive patients with the clinical diagnosis of condylomata acuminata who were treated with the combination of carbon dioxide laser and intralesional interferon-alpha 2B. We found the treatment regimen to be effective in decreasing the recurrence rate compared to laser treatment alone and it was well tolerated with only transient side effects in a minority of patients. We are encouraged by our result and have recently begun a randomized double-blind prospective study to provide more conclusive information regarding this treatment combination.     

Microvascular anastomosis with a low-output carbon dioxide (CO2) laser. I. Laser device, techniques and conditions of anastomosis

A low-output carbon dioxide laser was tentatively fabricated and applied to facilitate microvascular anastomosis. The femoral arteries and veins of Wistar albino rats were end-to-end anastomosed by either irradiating with a CO2 laser or the conventional technique of manual suturing. The CO2 laser was used at a power level of 21-40 mW and an exposure time of 5-15 sec. The patency rate was 96.2% for arteries and 92.6% for veins with the laser technique, while it was 97.6% for arteries and 78.0% for veins with the conventional technique. There was no significant difference between these two techniques in the patency rate of arteries, however, veins showed a significantly higher rate with the laser technique than with the conventional technique. The main advantages of the laser technique are that it is easier to perform and less time-consuming than the conventional technique of manual suturing.     

CO(2) laser surgery in the treatment of glottic cancer

BACKGROUND: The aim of the study was to assess the effectiveness of CO(2) laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions. METHODS: Seven hundred nineteen patients (687 men and 32 women; mean age, 60.4 years; range, 33-86 years) with glottic carcinoma (432 T1N0M0, 236 T2N0M0, 51 T3N0M0) underwent CO(2) laser surgery (mean follow-up, 5 years; range, 2-17 years). Statistical comparison was carried out with Wilcoxon test, considering p < .05 the minimum significance value. RESULTS: Overall actuarial survival, adjusted actuarial survival, and percentage of patients with no evidence of disease at 5 years were 85%, 97%, and 85%, respectively, in patients with T1a disease; 84%, 96%, and 83% in those with T1b disease; 77%, 86%, and 61% in those with T2 unilateral tumors; 77%, 88%, and 55% in those with T2 bilateral tumors; and 64%, 72%, and 60% in those with T3 disease. The statistical analysis showed the following: significant differences in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01), with the exception of no evidence of disease in the comparison of T2 versus T3 (p > .05); and no significant differences in the comparison of unilateral and bilateral tumors (p > .05). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 85%, 98%, and 99%, respectively, in patients with T1 disease; and 66%, 82%, and 91% in patients with T2 disease; and 66%, 83%, and 95% in patients with T3 disease. The laryngeal preservation rate was 97.3% in the T1 group, 82.5% in the T2 group, and 80.5% in T3 group. CONCLUSIONS: CO(2) laser endoscopic surgery is effective in the treatment of glottic carcinoma not infiltrating the cartilaginous skeleton; the results achieved are competitive with those of open conservative operations, if we take into account the possibilities afforded by salvage surgery and the rate of laryngeal preservation achieved in the study patients.     

Surgical treatment of ranula with carbon dioxide laser radiation

Ranula is a mucous extravasation cyst which appears as a swelling in the submental and submandibular regions. Several surgical techniques to manage ranula have been described in the literature, these techniques include the CO₂ laser radiation excision. Four patients were treated for intraoral ranula in the floor of the mouth by marsupialization with carbon dioxide laser radiation with defocused beam, continuous mode and 4 watts of power. There were no complications and no recurrences have occurred to date. The results showed that carbon dioxide laser radiation gives optimal results with no need for suture and good wound healing.     

超脉冲二氧化碳激光治疗汗管瘤的疗效观察

目的:评价超脉冲二氧化碳治疗汗管瘤的疗效.方法:采用超脉冲二氧化碳治疗汗管瘤30例(观察组),同时间段选取多功能电离子治疗汗管瘤30例(对照组),比较疗效和不良反应的发生.结果:观察组与对照组治愈率无明显差异(P>0.05),观察组不良反应的发生明显少于对照组(P<0.05).结论:超脉冲二氧化碳激光治疗汗管瘤简单易行,不良反应小,更易于患者接受.     

Rapid superpulse carbon dioxide laser treatment of urethral condylomata

Complete eradication of urethral condylomata was accomplished by rapid super-pulsed carbon dioxide laser in 4 patients. Minimal postoperative discomfort and lack of stricture formation indicate that this new modality is an advantageous, fast, and secure method of management of intraurethral condylomata, and substantiated by our previous experimental reports.     

Carbon dioxide (CO2) laser ablation of symptomatic vaginal endometriosis: a pilot study

Deep dyspareunia affects almost half of the women with endometriosis and is associated with vaginal endometriotic lesions. Our pilot study’s objective is to assess the feasibility and effectiveness of CO₂-laser ablation under colposcopic guidance for the treatment of symptomatic vaginal endometriosis. A non-comparative pilot study has been performed. Only women with histologically proven vaginal endometriosis, who declared the presence of moderate or severe deep dyspareunia, resistant to at least 6 months of conventional hormonal treatment, were deemed eligible for the study. All treatments were performed in an outpatient setting with a colposcopic-guided, hand-directed CO₂-laser. Variation in pain symptoms was measured with a 0- to 10-point numerical rating scale (NRS), in sexual functioning with the Female Sexual Function Index (FSFI), in psychological status with the Hospital Anxiety and Depression Scale (HADS), and in quality of life with the Short Form-12 questionnaire (SF-12). Satisfaction with treatment was evaluated according to a five-category scale (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied). Nineteen women were enrolled. No complications occurred. At 12-month follow-up, significant improvements were observed in deep dyspareunia and dyschezia scores, in FSFI, HADS, and in the physical component summary scores of SF-12, whereas the mental component score of SF-12 did not vary substantially. Most women (84%) were satisfied with the treatment received. CO₂-laser ablation for vaginal endometriosis could represent a valuable alternative option for women with symptomatic lesions, both in terms of amelioration of pain symptoms and improvement in quality of life and sexual function.

     

Thoracoscopic treatment of spontaneous pneumothorax using carbon dioxide laser

In an effort to improve the success rate of the previously described thoracoscopic electrocautery ablation technique of spontaneous pneumothorax, the carbon dioxide laser was evaluated in 12 patients. The recurrent (5 patients) or persistent (7 patients) spontaneous pneumothoraces were caused by rupture of (1) blebs in 6 patients, (2) intrapulmonary apical type II bullae in 3 patients, and (3) diffuse bullous emphysema, type III, in 3. The air leaks were successfully sealed in all but 1 patient with ruptured type II bulla. Surgical specimen from this single failure suggested that the entire inner lining of the bullae must be thermocoagulated. This technical modification led to successful outcome in 2 subsequent cases. With the use of carbon dioxide laser, it was possible to treat not only small blebs but all types of bullae causing spontaneous pneumothorax. Laser thoracoscopy is effective and safe in treating spontaneous pneumothorax.     

Argon and carbon dioxide laser treatment of hypertrophic and keloid scars

Laser physiology has shown that while wound healing is generally excellent after laser impaction, it nevertheless is delayed. It is thought that this factor may be important in the treatment of hypertrophic and keloid scars. These scars have been treated in a variety of ways with the laser, and the results, which have been good, are reported. A possible explanation of the complex mode of action has been given. It is thought that more work should be undertaken in this field.