Laser Surgery – any OPERATION in which the surgeon uses a device that focuses high-intensity lightwaves that generate heat to cut or ablate (destroy) tissue. Laser is an acronym for “light amplification by stimulated emission of radiation.” Lasers came into common use in medicine and surgery in the 1960s; the first applications were for the repair of detached RETINA.
The lightwave emission of a laser differs from ordinary light because it is
- all one wavelength (monochromatic)
- organized and unified
- directional and concentrated
There are different types of lasers, classified according to the mechanism by which they produce lightwaves, the length of the lightwaves, and the pattern of emission (continuous or pulsed). The different wavelengths and pulse patterns of emitted light permit targeted use of lasers from making incisions (cutting) to treating discolorations of the SKIN such as a port wine stain BIRTHMARK. The laser’s lightwave determines what tissues will absorb the light and what tissues will allow the light to pass through them. For example, the BLOOD in blood vessels absorbs the yellow light of the pulsed laser, though the pigment of light-colored skin does not. Most lasers emit lightwaves in the infrared spectrum; the “cool” lasers emit lightwaves in the ultraviolet spectrum.
Laser lightwaves, like other lightwaves, can travel via fiberoptics, allowing the surgeon to direct the laser emission to a specific location, even one that is deep within the body. Laser surgery requires the surgeon to complete specialized training and requires specialized equipment and facilities for safe use.
Surgical lasers have increased options in all areas of surgery but have revolutionized two areas of treatment in particular: ophthalmologic (EYE) surgery and dermatologic (skin) surgery. The surgeon can so precisely focus and target the laser’s beam that any incidental damage to surrounding tissue is nearly nonexistent. Laser surgery incisions tend to heal with minimal scarring. The heat the laser generates kills BACTERIA on the skin at the incision site, reducing the risk for postoperative INFECTION. As well, the intense heat instantly seals blood vessels to reduce bleeding at the site of the incision, making the surgical laser the instrument of choice for BLOODLESS SURGERY as well as for treating vascular disorders of the skin such as birthmarks.
|Types of Surgical Lasers|
|Laser Type||Characteristics||Surgical Application|
|argon gas||shallow penetration|
only pigmented tissues and fluids absorb the lightwaves
refractive surgery (vision correction)
coagulate bleeding BLOOD vessels
|carbon dioxide (CO2)||shallow penetration|
only pigmented fluids absorb the lightwaves
|instead of scalpel for incisions|
vaporize tissue (including tumors)
dermatologic procedures such as SKIN resurfacing
|neodymium:yttriumaluminum garnet (Nd:YAG)||deep penetration|
all fluids in the body absorb the lightwaves
|fiberoptic transfer to locations within the body|
vaporize or shrink tumors
remove pigmented lesions
|pulsed dye||shallow penetration|
|port wine stain and other vascular birthmarks|
Because the intense light the laser generates can burn the RETINA and cause permanent blindness, people undergoing laser surgery as well as the surgeon and other members of the surgical team must wear EYE protection when the laser is in use.
Laser surgery has the same risks as conventional surgery for bleeding and infection, and carries additional risk for BURNS and related damage. A laser can permanently discolor the skin, particularly the skin of people of color (notably African Americans, Asian Americans, and Hispanic Americans). Lasers may also cause burns of the skin. Though laser surgery makes many operations easier and more comfortable, it is important to choose a surgeon who is qualified to perform laser surgery and to fully understand the potential benefits and risks of laser surgery compared to conventional surgery.