Low level laser therapy: A review

The biological and clinical effects of sub-thermal doses of laser light is an area of some controversy. In this review the published scientific evidence for such effects is examined with particular reference to the physics of the light delivery and dosimetry.     

Low intensity laser therapy: Still not an established clinical tool

The surgical, ophthalmological, and dermatological applications of high power lasers are well known and easily understood. What is neither as well known nor as easily understood is that lasers at powers that are orders of magnitude smaller have also been used in the laboratory and clinic for nearly 30 years to modulate cell function, lessen pain, and accelerate healing of soft tissue injuries. This article analyzes the rationale of this approach, examines the utility of laser therapy in its most common clinical applications, reviews and synthesizes the findings, and concludes that although laboratory findings seem authentic, clinical utility remains unestablished. © 1995 Wiley-Liss, Inc.     

Low reactive laser therapy

The type, characteristics and effect of low reactive laser equipment used for pain treatment in Japan are described in this section. Currently, low reactive laser therapy equipments marketed and used in Japan include diode laser therapeutic device with semiconductor as a medium consisting of aluminum, gallium and arsenic. Low reactive laser equipment comes in three models, the first type has a capacity of generating 1,000 mW output, and the second type has a capacity of generating 10 W output. The third type has four channels of output, 60, 100, 140 and 180 mW and we can select one channel out of the four channels. This model is also used as a portable device because of its light weight, and we can carry it to wards and to the outside of the hospital. Semiconductor laser has the capacity of deepest penetration and the effect tends to increase proportionally to the increasing output. Low reactive laser therapy is less invasive and lower incidence of complications. Although low reactive laser therapy might be effective for various pain disorders, the effect is different depending on the type of pain. We should keep in mind that this therapy will not give good pain relief equally in all patients with pain.     

Low‐level laser therapy for fat layer reduction: A comprehensive review

Background and Objective

Low‐level laser (light) therapy (LLLT) is a noninvasive, nonthermal approach to disorders requiring reduction of pain and inflammation and stimulation of healing and tissue regeneration. Within the last decade, LLLT started being investigated as an adjuvant to liposuction, for noninvasive body contouring, reduction of cellulite, and improvement of blood lipid profile. LLLT may also aid autologous fat transfer procedures by enhancing the viability of adipocytes. However the underlying mechanism of actions for such effects still seems to be unclear. It is important, therefore, to understand the potential efficacy and proposed mechanism of actions of this new procedure for fat reduction.

Materials and Methods

A review of the literature associated with applications of LLLT related to fat layer reduction was performed to evaluate the findings from pre‐clinical and clinical studies with respect to the mechanism of action, efficacy, and safety.

Results

The studies as of today suggest that LLLT has a potential to be used in fat and cellulite reduction as well as in improvement of blood lipid profile without any significant side effects. One of the main proposed mechanism of actions is based upon production of transient pores in adipocytes, allowing lipids to leak out. Another is through activation of the complement cascade which could cause induction of adipocyte apoptosis and subsequent release of lipids.

Conclusion

Although the present studies have demonstrated safety and efficacy of LLLT in fat layer reduction, studies demonstrating the efficacy of LLLT as a stand‐alone procedure are still inadequate. Moreover, further studies are necessary to identify the mechanism of action. Lasers Surg. Med. 45:349–357, 2013. © 2013 Wiley Periodicals, Inc.     

Hand-assisted laparoscopic colorectal surgery: an evidence-based review

Despite its increasing use by practitioners, laparoscopic colorectal surgery remains technically challenging. Hand-assisted laparoscopic colorectal surgery may represent a viable hybrid alternative approach to standard laparoscopy. Although few high-quality studies have been carried out, hand-assistance appears to reduce operative time when compared to straight laparoscopy for both left-sided segmental colonic and total colorectal resections. Moreover, hand-assistance appears to maintain the short-term benefits of laparoscopy, while affording the surgeon with the ability to carry out complex cases in a minimally invasive fashion. Data pertaining to the use of hand-assistance for rectal cancer surgery are currently lacking. One the whole, hand-assisted laparoscopic colorectal surgery appears to be a useful tool for the minimally invasive surgeon, one that is perhaps best thought of as an adjunct to simple laparoscopy.     

Hand hygiene: an evidence-based review for surgeons

This review of the literature discusses the scientific evidence behind using different hand hygiene agents on the surgical ward, and in theatre for preoperative disinfection. It considers the mechanism of action of the agents and their effectiveness against different pathogens, as well as possible future agents, and how they are tested. It addresses problems such as the poor compliance with hand hygiene guidelines by healthcare workers (especially doctors) and investigates what can be done to improve compliance. Finally, it demonstrates the reduction in hospital acquired infection (HAI) rate that can be achieved by improving hand hygiene compliance, and shows that the savings associated with this easily outweigh the cost.     

Low level laser therapy for healing acute and chronic wounds - the extendicare experience

The purpose of the study is to assess the effectiveness of low level laser therapy for wound healing when combined with the Extendicare Wound Prevention and Management Program. Sixteen residents at a Canadian Extendicare nursing home had a total of 27 sites treated consisting of 23 open wounds and 4 'at risk' areas. Of the 23 open wounds, two wounds in between toes were not able to be 'traced' and deemed 'immeasurable' wounds, resulting in 21 open, measured wounds. The four 'at risk' (closed) areas were treated preventatively. Pressure, venous insufficiency and diabetic wounds were included. The majority (12/21) or 57.1%, of the wounds were chronic (>or=3 months duration) and 42.9% were acute (<3 months duration). The primary outcome measures included the PUSH Tool score, EZ Graph tracings and photographs. Secondary outcome measures were employed to better understand potential barriers to successful integration into clinical practice. Feedback on the effectiveness of low level laser therapy, the education program and determinations of hands-on relevance was sought from staff. At the end of the 9-week trial, the majority (61.9%) of the 21 wounds achieved significant improvement (>or=50% wound closure). Nine (42.8%) had 100% closure. Some improvement was seen in 14.3% and 23.8% of wounds demonstrated no change. Chronic and acute wounds had similar improvement. None of the wounds in this debilitated, frail population deteriorated during the study and no negative consequences of treatment were encountered. Without staff support, even if new technology has positive clinical outcomes, success would be limited. Staff rated low level laser, easy to learn and use, effective for the majority of their residents worth the additional time. Staff requested a continuation of low level laser even after study completion.     

Psychosocial factors and surgical outcomes: an evidence-based literature review

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.     

Open repair of inguinal hernia: an evidence-based review

This article provides an evidence-based review of open hernia repair. Technical considerations in general, including perioperative management of the patient, and the most currently used open repairs are addressed. Outcomes after repair are reviewed using the latest available literature. Current recommendations from this review include the routine use of mesh in primary repair of inguinal hernia and the need to counsel patients preoperatively about the risk of chronic postoperative groin pain.     

Laparoscopic urinary stone surgery: an updated evidence-based review

The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B).     

Massive transfusion: an evidence-based review of recent developments

The design and implementation of massive transfusion protocols with ratio-based transfusion of blood and blood products are important and active areas of investigation. A significant yet controversial body of literature exists to support the use of hemostatic resuscitation in massive transfusion and new data to support the use of adjuncts, such as recombinant factor VIIa and tranexamic acid. We review the developments in massive transfusion research during the past 5 years, including protocol implementation, hemostatic resuscitation, the use of tranexamic acid, and goal-directed therapy for coagulopathy. Furthermore, we provide a level of evidence analysis of the data surrounding the use of component therapy and recombinant factor VIIa in massive transfusion, summary recommendations for the various agents of resuscitation, and new methods of goal-directed therapy.     

Pyloric stenosis in pediatric surgery: an evidence-based review

Pyloric stenosis is a common pediatric surgical problem that requires a combination of both medical and surgical attention. This article reviews the classical elements necessary to care for the patient in a safe and effective manner. A well-tested management approach that can be applied to the general surgical environment is described. Perioperative management of the patient is discussed and the currently used techniques are reviewed. Current recommendations include the routine use of ultrasonography for diagnosis, attention to the preoperative correction of electrolytes, and the use of minimally invasive techniques for treatment.