CO2 laser surgery in urology

The characteristics, advantages, and disadvantages of the CO2 laser to various clinical situations in urologic surgery are described and evaluated. Conditions treated routinely with the laser are presented and future possible uses discussed.     

Use of the laser in urology

The usage of laser therapy in urology is based upon thermal effects that lead to tissue destruction by coagulation necrosis and volatilization. The endoscopic treatment of bladder tumors has been its most important utilization. The authors report their experience with 681 bladder tumors in 198 patients and present the technical details of laser therapy, the indications and the results. The recurrence rate at the previously treated tumor area was found to be rather improved: 0.75/100 months/patient for stage pTa and 0.92/100 months/patient for stage pT1. Other utilizations for laser therapy exist: upper tract urothelial tumors mainly in selected cases as solitary kidney; urethral localizations of urothelial tumors and condylomata acuminata; urethral stenosis, as a complement of optical urethrotomy; hemorrhagic cystitis after radiotherapy and some forms of chemotherapy. The pulsed dye laser may become an important advance in endoscopic treatment of ureteral calculi.     

Use of the holmium:YAG laser in urology.

The tissue effects of a holmium:YAG (Ho:YAG) laser operating at a wavelength of 2.1 mu with a maximum power of 15 watts (W) and 10 different energy-pulse settings was systematically evaluated on kidney, bladder, prostate, ureteral, and vasal tissue in the dog. In addition, various urologic surgical procedures (partial nephrectomy, transurethral laser incision of the prostate, and laser-assisted vasovasostomy) were performed in the dog, and a laparoscopic pelvic lymph node dissection was carried out in a pig. Although the Ho:YAG laser has a strong affinity for water, precise tissue ablation was achieved in both the contact and non-contact mode when used endoscopically in a fluid medium to ablate prostatic and vesical tissue. Using the usual parameters for tissue destruction (blanching without charring), the depth of thermal injury in the bladder and ureter was kept superficial. In performing partial nephrectomies, a 2-fold reduction in the zone of coagulative necrosis was demonstrated compared to the use of the continuous wave Neodymium:YAG laser (Nd:YAG). When used through the laparoscope, the Ho:YAG laser provided precise cutting and, combined with electrocautery, allowed the dissection to proceed quickly and smoothly. Hemostatic control was adequate in all surgical procedures. Although the results of these investigations are preliminary, our initial experience with the Ho:YAG laser has been favorable and warrants further investigations.     

Use of CO2 laser knife in gastroenterological surgery

Favourable results obtained by using the RT TLS61 CO2 laser of TUNGS-RAM, of a performance of 60 W are reported. It is emphasized that the device has several advantages in surgical gastroenterology over the traditional cutting instruments. The light of the device coagulates the smaller than 0.5 mm vessels during cutting. On opening the gastrointestinal tract-contrary to electrocautery-the necrotic zone is narrower, which may be of importance from the point of view of suture insufficiency. The device provides more favourable conditions for ablastic operations than do the traditional cutting instruments.     

Use of the CO2 laser beam in combined maxillofacial operations

A CO2 laser ray of 80-100 vt was used in performing combined operations for malignant tumors of the maxillofacial area. The observations have shown the "block" operations performed with the CO2 laser ray to have many advantages over similar operations fulfilled by a traditional method.     

Use of the CO2 laser in soft tissue dental surgery

The use of the carbon dioxide laser for the removal of soft tissue lesions in the oral cavity is presented. The laser was used to remove numerous benign lesions and growths, for incisional and excisional biopsies, and for the removal of microinvasive and macroinvasive carcinomas. Owing to its coagulation properties, the laser was used effectively in treating patients with oral lesions compounded by blood dyscrasias. Because of the advantages of a relatively bloodless surgery; decreased postoperative discomfort; minimal swelling and scarring; and the laser's ability to coagulate, vaporize, or cut, the CO2 surgical laser offers the dental surgeon a viable and in many cases an improved alternative to the scalpel. Laser techniques and several case reports are discussed.     

Use of CO2 laser in the treatment of skin hemangiomas in children

The use of the CO2-laser in the treatment of hemangiomas in children is very promising because it opens new possibilities of "conservative surgery", reducing the terms of treatment, improving the cosmetic results, besides, there are no difficult anatomical localizations for the method. The choice of optimal radiation parameters allows the unique properties of laser energy to be exhibited effectively in extradermal pediatric surgery.     

Use of CO2 laser for surgical debridement of wounds

The article deals with the results of experimental research in determining the optimum parameters of laser radiation for surgical debridement of wounds and the techniques of its performance. It presents the results of treatment of 137 patients with incised wounds of various localization with the use of a carbon dioxide laser beam. Sterility of the wound surface was produced in 96-97% of cases after wound debridement with a laser beam; uncomplicated healing of wounds was noted in 90% of cases. It is concluded from the results of the research that debridement of wounds with the beam of carbon dioxide laser creates favourable conditions for early closure of the wound surface with sutures, prevents the development of serious purulent complications, shortens the terms of treatment, and produces a good functional and cosmetic results.     

Use of CO2 laser for the prevention of postoperative wound suppuration

The experiments with laboratory animals have convincingly shown that CO2-laser can be successfully used for prophylactics of suppurations of postoperative wounds in clinics.     

Use of the CO2 laser for malignant disease of the oral cavity

The CO2 laser has provided the otolaryngologist/head and neck surgeon with a valuable addition in the diagnosis and treatment of malignant disease of the oral cavity. It is also helpful in the treatment of the premalignant clinical leukoplakias of the oral cavity. Carcinoma in situ has been diagnosed and treated successfully with the CO2 laser. The T1 carcinomas of the tongue, floor of mouth, and tonsil can be successfully managed with the CO2 laser. It also offers the patient a relatively painless method of debulking large obstructing tumors. Other advantages of the CO2 laser include hemostasis, precise visualization, and less edema and pain than the conventional techniques.     

Use of the CO2 laser in the surgical treatment of complicated echinococcosis of the liver

The article discusses experience in the use of high-energy CO2 laser in the treatment of 108 patients with complicated forms of echinococcosis of the liver. The diagnostic efficacy of instrumental methods of examination is determined. The most informative are ultrasonic echolocation (96.8%) and computered tomography (100%). They allow exact localization of the cyst, which is important in the choice of the operative approach. The use of the laser for excising the fibrous capsule and treating the residual cavity makes is possible to: abandon the traditional methods for completing echinococcectomy (drainage of the residual cavity, marsupialization, capitonnage), exclude suppuration of the residual cavity, reduce markedly the period of the patient's hospitalization.