Laser surgery

Laser (light amplification by stimulated emission of radiation) surgery usesan 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. It is generally used to cut or destroy tissue that is abnormalor diseased without harming healthy, normal tissue; shrink or destroy tumorsand lesions; or cauterize (seal) blood vessels to prevent excessive bleeding.

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.

The first working laser was introduced in 1960. The device was initially usedto 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.

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 itcuts 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 dyesto shrink or dissolve tumors.

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 removedor 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, andother conditions that impair sight
  • Migraine headaches
  • Non-cancerous enlargement of the prostate gland
  • Nosebleeds
  • Ovarian cysts
  • Ulcers
  • Varicose veins
  • Warts
  • Andnumerous other conditions, diseases, and disorders.

Often referred to as "bloodless surgery," laser procedures usually involve less bleeding than conventional surgery. The heat generated by the laser keepsthe surgical site free of germs and reduces the risk of infection. Because asmaller incision is required, laser procedures often take less time (and costless 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 thoroughlytrained 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 properly 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 ina non-hospital setting.

Because laser surgery is used to treat so many dissimilar conditions, the patient should ask his physician for detailed instructions about how to preparefor 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 healthand 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.

Laser surgery can 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 ofthe 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 supposedto 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.

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