The term laser means light amplification by stimulated emission of radiation, and it uses a laser light source (laser beam) to remove tissues that are diseased or to treat blood vessels that are bleeding. Laser beams are strong beams of light produced by electrically stimulating a particular material. A solid, a liquid, or a gas is used. Alternatively, the laser is used cosmetically; it can remove wrinkles, birthmarks, or tattoos.
The special light beam is focused to treat tissues by heating the cells until they burst. There are a number of different laser types. Each has a different use and color. The color, or the light beam, relates to the type of surgery that is being performed and the color of the tissue that is being treated. There are three types of laser: the carbon dioxide (CO 2 ) laser; the YAG laser (yttrium aluminum garnet); and the pulsed dye laser.
Laser surgery is used to:
Anyone who is thinking about having laser surgery should ask the surgeon to:
Because some lasers can temporarily or permanently discolor the skin of blacks, Asians, and Hispanics, a dark-skinned patient should make sure that the surgeon has successfully performed laser procedures on people of color. Potential problems include infection, pain, scarring, and changes in skin 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.
Additionally, because some laser surgical procedures are performed under general anesthesia, its risks should be fully discussed with the anesthesiologist. The patient should fully disclose all over-the-counter and prescription medications that are being taken, as well as the foods and beverages that are generally consumed; some can interact with agents used in anesthesia.
Lasers can be used to perform almost any surgical procedure. In fact, general surgeons employ the various laser wavelengths and laser delivery systems to cut, coagulate, vaporize, and remove tissue. In most "laser surgeries," they actually use genuine laser devices in place of conventional surgical tools—scalpels, cryosugery probes, electrosurgical units, or microwave devices—to carry out standard procedures, like mastectomy (breast surgery). With the use of lasers, the skilled and trained surgeon can accomplish tasks that are more complex, all the while reducing blood loss, decreasing postoperative patient discomfort, decreasing the chances of infection to the wound, reducing the spread of some cancers, minimizing the extent of surgery (in some cases), and achieving better outcomes in wound healing. Also, because lasers are more precise, the laser can penetrate tissue by adjusting the intensity of the light.
Lasers are also extremely useful in both open and laparoscopic procedures. Common surgical uses include breast surgery, removal of the gallbladder, hernia repair, bowel resection , hemorrhoidectomy , solid organ surgery, and treatment of pilonidal cyst.
The first working laser was introduced in 1960. Initially used to treat diseases and disorders of the eye, the device was first 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 to pioneer laser surgery, and developed and improved upon many early techniques and more refined surgical procedures.
The three types of lasers most often used in medical treatment are the:
Sometimes described as "scalpels of light," lasers are used alone or with conventional surgical instruments in a array of procedures that:
Laser surgery is often standard operating procedure for specialists in:
Routine uses of lasers, include eliminating birth-marks, skin discoloration, and skin changes due to aging, and removing benign, precancerous, or cancerous tissues or tumors. Lasers are used to stop a patient's 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:
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.
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 urges that:
Because laser surgery is used to treat so many diverse conditions, the patient should ask the 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 , a medical history, and conversation with the patient that:
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 recovery from the anesthesia is complete, unless a responsible adult is available to accompany the patient home.
The doctor may prescribe analgesic (pain-relieving) medication, and should provide easy-to-understand, written instructions on how to take the medication. The doctor should also be able to give the patient a good estimate of how the patient's recovery should progress, the recovery time, and what to do in case complications or emergency arise. The amount of time it takes for the patient to recover from surgery depends on the surgery and on the individual. Recovery time for laser surgery is, for the most part, faster than for traditional surgery.
Like traditional surgery, laser surgery can be complicated by:
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 has said that both doctors and patients must use special wavelength-specific, protective eyewear whenever a CO 2 laser is used.
There are other kinds of dangers that laser surgery can impose of which the patient should be aware. Laser beams have the capacity to do a great deal of damage when coupled with high enough energy and absorption. They can ignite clothing, paper, and hair. Further, the risk of fire from lasers increases in the presence of oxygen. Hair should be protected and clothing should be tied back, or removed, within the treatment areas. It is important to guard against electric shock, as lasers require the use of high voltage. Critically, installation must ensure proper wiring.
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.
All of the above risks, precautions, and potential complications should be discussed by the doctor with the patient.
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, and enjoy longer, fuller, more active lives.
A patient who is considering any kind of laser surgery should ask the 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 a normal appearance is regained and the patient can resume normal activities.
A person who is considering any type of laser surgery should ask the 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- or dark-skinned individual. This abnormal pigmentation may or may not disappear over time.
Scarring or rupturing of the cornea is uncommon, but laser surgery on one or both eyes can:
Signs of infection following laser surgery include:
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Laith Farid Gulli, M.D., M.S.
Randi B. Jenkins, B.A.
Bilal Nasser, M.D., M.S.
Robert Ramirez, B.S.