Lasers in Endoscopy

Lasers in Endoscopy


INTRODUCTION

Laser, the acronym for Light Amplification by Stimulated Emission of Radiation is merely a beam of ordinary light radiation. Visible light which is a day-to-day experience in our natural environment, represents only one facet of a much broader physical phenomenon known as electro-magnetic radiation.

The unique properties of laser radiation that differentiates it from ordinary light are:

a. It is monochromatic as it is made up of identical atoms all emitting photons of the same wave length.

b. It is coherent

c. The beam being parallel to the longitudinal axis of the tube features a very low angular divergence.

The clinical implications of these properties are far reaching and allows the surgeon to focus the beam precisely on the target area.

In the hands of a skilled surgeon, the laser becomes an instrument capable of inducing desired therapeutic effects, far beyond the scope of conventional surgical tools such as cold knives or electro cautery probes. Precise incision can be performed, lesions extending over large areas can be vapourized, voluminous lesions can be debulked and destroyed by ablation or necrotization.

Laser energy can be delivered to tissue in a variety of ways: by contact or from a distance. In majority of cases, laser provides a largely haemostatic effect where the surgeon enjoys the convenience of a dry and clear field. Moreover the extent of injury to the surrounding tissue is to a high degree controllable. The laser enables the surgeon to reach anatomical structures whose size or location render them inaccessible to any other known surgical instrument. Consequently the post operative complications, pain or irreversible damage is reduced considerably.

The properties which make laser so unique are:

 High precision of incision

 Controlled depth of penetration

 Minimal bleeding

 Minimal damage to adjacent structures

 Better healing with minimal scar tissue

 Less post operative pain

Commonly used lasers in gynaecology are carbon dioxide and ND: YAG (Neo Dynium Ytrium Aluminium Garnet) Lasers.

The CO2 laser features a wave length of 10.6 microns in the far infra red range. It is strongly absorbed by water. CO2 laser is readily absorbed by the first twoellular layers of tissue, constituting the first 100Mm. Consequently this is a laser used for superficial treatment.

The various limitations of CO2 laser are:

• Need to use a cumbersome instrument

• Inability to work in liquid medium, hence it cannot be used in hysteroscopy

• Excessive smoke production.

Nd: YAG laser features a wavelength of 1.06 Mm (near infra red) It creates a deep and laterally extended ball of affected tissue, 3-5 mm in diameter. Nd: YAG laser is ideal for the treatment of lesions located in liquid filled cavities such as the bladder and the uterus filled with a distension liquid, as water is completely transparent to this type of radiation.

The various conditions in which lasers can be used in gynaecology are infertility, chronic pelvic pain, endometriosis, ectopic pregnancy and fibroids.