Laser Surgery

Laser (light amplification by stimulated emission of radiation) surgery uses an intensely hot, precisely focused beam of light to remove or vaporize tissue and control bleeding in a wide variety of non-invasive and minimally invasive procedures.

Purpose

Laser surgery is used to:

• cut or destroy tissue that is abnormal or diseased without harming healthy, normal tissue
• shrink or destroy tumors and lesions
• cauterize (seal) blood vessels to prevent excessive bleeding

Precautions

Anyone who is thinking about having laser surgery should ask his doctor to:

• explain why laser surgery is likely to be more beneficial than traditional surgery
• describe his experience in performing the laser procedure the patient is considering

Because some lasers can temporarily or permanently discolor the skin of Blacks, Asians, and Hispanics, a dark-skinned patient should make sure that his surgeon has successfully performed laser procedures on people of color.

Some types of laser surgery should not be performed on pregnant women or on patients with severe cardiopulmonary disease or other serious health problems.

Description

The first working laser was introduced in 1960. The device was initially used to treat diseases and disorders of the eye, whose transparent tissues gave ophthalmic surgeons a clear view of how the narrow, concentrated beam was being directed. Dermatologic surgeons also helped pioneer laser surgery, and developed and improved upon many early techniques and more refined surgical procedures.

Types of lasers

The three types of lasers most often used in medical treatment are the:

• Carbon dioxide (CO₂) laser. Primarily a surgical tool, this device converts light energy to heat strong enough to minimize bleeding while it cuts through or vaporizes tissue.
• Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Capable of penetrating tissue more deeply than other lasers, the Nd:YAG makes blood clot quickly and can enable surgeons to see and work on parts of the body that could otherwise be reached only through open (invasive) surgery.
• Argon laser. This laser provides the limited penetration needed for eye surgery and superficial skin disorders. In a special procedure known as photodynamic therapy (PDT), this laser uses light-sensitive dyes to shrink or dissolve tumors.

Laser applications

Sometimes described as "scalpels of light," lasers are used alone or with conventional surgical instruments in a diverse array of procedures that:

• improve appearance
• relieve pain
• restore function
• save lives

Laser surgery is often standard operating procedure for specialists in:

• cardiology
• dentistry
• dermatology
• gastroenterology (treatment of disorders of the stomach and intestines)
• gynecology
• neurosurgery
• oncology (cancer treatment)
• ophthalmology (treatment of disorders of the eye)
• orthopedics (treatment of disorders of bones, joints, muscles, ligaments, and tendons)
• otolaryngology (treatment of disorders of the ears, nose, and throat)
• pulmonary care (treatment of disorders of the respiratory system
• urology (treatment of disorders of the urinary tract and of the male reproductive system)

Routine uses of lasers include erasing birthmarks, skin discoloration, and skin changes due to aging, and removing benign, precancerous, or cancerous tissues or tumors. Lasers are used to stop snoring, remove tonsils, remove or transplant hair, and relieve pain and restore function in patients who are too weak to undergo major surgery. Lasers are also used to treat:

• angina (chest pain)
• cancerous or non-cancerous tumors that cannot be removed or destroyed
• cold and canker sores, gum disease, and tooth sensitivity or decay
• ectopic pregnancy (development of a fertilized egg outside the uterus)
• endometriosis
• fibroid tumors
• gallstones
• glaucoma, mild-to-moderate nearsightedness and astigmatism, and other conditions that impair sight
• migraine headaches
• non-cancerous enlargement of the prostate gland
• nosebleeds
• ovarian cysts
• ulcers
• varicose veins
• warts
• and numerous other conditions, diseases, and disorders

Advantages of laser surgery

Often referred to as "bloodless surgery," laser procedures usually involve less bleeding than conventional surgery. The heat generated by the laser keeps the surgical site free of germs and reduces the risk of infection. Because a smaller incision is required, laser procedures often take less time (and cost less money) than traditional surgery. Sealing off blood vessels and nerves reduces bleeding, swelling, scarring, pain, and the length of the recovery period.

Disadvantages of laser surgery

Although many laser surgeries can be performed in a doctor's office rather than in a hospital, the person guiding the laser must be at least as thoroughly trained and highly skilled as someone performing the same procedure in a hospital setting. The American Society for Laser Medicine and Surgery, Inc. urges that:

• all operative areas be equipped with oxygen and other drugs and equipment required for cardiopulmonary resuscitation (CPR)
• non-physicians performing laser procedures be proper-ly trained, licensed, and insured
• a qualified and experienced supervising physician be able to respond to and manage unanticipated events or other emergencies within five minutes of the time they occur
• emergency transportation to a hospital or other acute-care facility be available whenever laser surgery is performed in a non-hospital setting

Cosmetic laser surgery in progress.The wavelengths of the laser's light can be matched to a specific target, enabling the physician to destroy the capillaries near the skin's surface without damaging the surrounding tissue. (Photograph by Will & Deni McIntyre, Photo Researchers, Inc. Reproduced by permission.)

Imprecisely aimed lasers can burn or destroy healthy tissue.

Preparation

Because laser surgery is used to treat so many dissimilar conditions, the patient should ask his physician for detailed instructions about how to prepare for a specific procedure. Diet, activities, and medications may not have to be limited prior to surgery, but some procedures require a physical examination and a medical history that:

• determines the patient's general health and current medical status
• describes how the patient has responded to other illnesses, hospital stays, and diagnostic or therapeutic procedures
• clarifies what the patient expects the outcome of the procedure to be

Aftercare

Most laser surgeries can be performed on an outpatient basis, and patients are usually permitted to leave the hospital or medical office when their vital signs have stabilized. A patient who has been sedated should not be discharged:

• until he has recovered from the anesthesia and knows who and where he is
• unless he is accompanied by a responsible adult

The doctor may prescribe analgesic (pain-relieving) medication, and should provide easy-to-understand written instructions that describe how the patient's recovery should progress and what to do in case complications or emergency arise.

Risks

Like traditional surgery, laser surgery can be complicated by:

• hemorrhage
• infection
• perforation (piercing) of an organ or tissue

Laser surgery can also involve risks that are not associated with traditional surgical procedures. Being careless or not practicing safe surgical techniques can severely burn the patient's lungs or even cause them to explode. Patients must wear protective eye shields while undergoing laser surgery on any part of the face near the eyes or eyelids, and the United States Food and Drug Administration (FDA) has said that both doctors and patients must use special protective eyewear whenever a CO2 laser is used.

Laser beams can burn or destroy healthy tissue, cause injuries that are painful and sometimes permanent, and actually compound problems they are supposed to solve. Errors or inaccuracies in laser surgery can worsen a patient's vision, for example, and lasers can scar and even change the skin color of some patients.

Normal results

The nature and severity of the problem, the skill of the surgeon performing the procedure, and the patient's general health and realistic expectations are among the factors that influence the outcome of laser surgery. Successful procedures can enable patients to:

• feel better
• look younger
• enjoy longer, fuller, more active lives

A patient who is considering any kind of laser surgery should ask his doctor to provide detailed information about what the outcome of the surgery is expected to be, what the recovery process will involve, and how long it will probably be before he regains a normal appearance and can resume his normal activities.

Abnormal results

A person who is considering any type of laser surgery should ask his doctor to provide specific and detailed information about what could go wrong during the procedure and what the negative impact on the patient's health or appearance might be.

Lighter or darker skin may appear, for example, when a laser is used to remove sun damage or age spots from an olive-skinned or dark-skinned individual. This abnormal pigmentation may or may not disappear in time.

Scarring or rupturing of the cornea is uncommon, but laser surgery on one or both eyes can:

• increase sensitivity to light or glare
• reduce night vision
• permanently cloud vision, or cause sharpness of vision to decline throughout the day

Signs of infection following laser surgery include:

• burning
• crusting of the skin
• itching
• pain
• scarring
• severe redness
• swelling