Endoscopic Laser Surgery

This book is concerned primarily with operative endoscopy utilizing lasers, presenting proved and future endoscopic applications of lasers in medicine. It includes new concepts of cancer therapy, such as photodynamic therapy, because of the laser's endoscopic application.

Learn how to use a powerful medical advance in head and neck oncology – from the masters of the technique! The name Wolfgang Steiner is synonymous with transoral laser microsurgery for head and neck cancer. He has tirelessly promoted this innovative technique throughout the world and his clinic is considered the pioneering center in Europe. Thousands of students and practitioners have benefited from his teaching and lectures, allowing them to treat selected patients more safely and effectively than ever thought possible. Now for the first time, you have at your fingertips Dr. Steiner's detailed, step-by-step techniques for transoral laser microsurgery of the head and neck, showing how to excise tumors, preserve the larynx and other key structures, and dramatically decrease mortality. You will learn the insights and technical refinements that allow you to tailor your surgery to the extent of the cancer, even eradicating it in certain localized areas. You will see how to work in a fraction of the time, avoid complex throat and neck reconstructions, preserve voice structures, and greatly enhance the patient's quality of life. Special features of this landmark book include: Written by the developers of this innovative, minimally invasive technique 300 endoscopic color images and explanatory drawings illustrate the diagnostic and surgical procedures on a step-by-step basis Ideal for students as well as for practitioners seeking to broaden their treatment options Offers an introduction to a rapidly growing standard in the field of head and neck oncology For the beginner as well as the experienced surgeon, this book offers masterful guidance on using modern laser technology to perform conservative laryngeal and other head and neck cancer surgeries, resulting in well-documented, lower morbidity rates. It will upgrade and enrich your skills and open a wide range of treatment options that you can offer your patients. Stay up-to-date with new technology; reserve your copy today! "To those who believe, no explanation is necessary, but the Steiner book delivers technical refinements and insights that will expand the surgeon's skill. To those who are skeptical, the book addresses the basic principles of...a great adventure and probably the major positive change in head and neck oncology of the last three or four decades."—From the Foreword by Lawrence W. Desanto, MD, Professor Emeritus, Mayo Medical School, Rochester, Minnesota

There has been incredible progress over the last decade in therapeutic endoscopy. Such therapies are either easier now than ten years ago or are possible when previously they were inconceivable. These advances have depended upon major improvements in diagnostic endoscopy for different subspecialties. Simultaneously, a major innovation for therapeutics through endoscopes is the application of medical lasers. This book is written by renowned biophysicists and laser endoscopists of different sub specialties where the application of lasers has revolutionized medical care. In some cases treatments which were not previously possible are now routine. Laser palliation of obstructing tumors in different sub specialties is an example of this. In other cases, resective surgery is obviated by the application of lasers via endoscopy such as for the control of gastrointestinal bleeding. The authors of different medical or surgical subspecialties which use endoscopic lasers write about the pathology and clinical problems, their personal experience and results. However, they also emphasize their techniques of laser endoscopy through case examples, technical discussions, and colored illustrations. Their discussions will give the reader a better understanding about the role of laser treatment of different conditions compared to routine medical or surgical therapy. In several instances, randomized controlled trials involving medical lasers were discussed in this book because they fundamentally changed our understanding of common problems such as upper gastrointestinal bleeding. We predict continued progress in therapeutic endoscopy.

The Nd:YAG laser has finally become the multidisciplinary and muitispeciaity tool of the 1980s. Primarily developed for gastrointestinal applications for controlling bleeding, at present it is also used for endoscopic treatment of gastrointestinal tumors, endobronchial cancer, and bladder and gynecological lesions and finding applications in otorhinolaryngology and neurosurgery. De velopment of laser scalpels and focusing head-pieces has now allowed the Nd:YAG laser to be used for open surgical procedures in general and plastic surgery, head and neck surgery, urology, gynecology, dermatology, and neu rosurgery. The rapid development in ceramic technology has led to contact surgery allowing physicians a choice of excision, vaporization, coagulation, incision, or combinations thereof by easily changing probes rather than having to select new laser wavelengths. This technology is rapidly replacing the carbon dioxide laser which currently has no adequate flexible waveguide for fiberoptic en doscopy, cannot be used in a water medium (e.g., bladder), and has poor coagulation properties when compared to the Nd:YAG laser. Future developments may see the Nd:YAG laser even replacing electro cautery in the operating room due to its greater safety and efficacy. Local hyperthermia (laserthermia) with computer control, photodynamic therapy, and ophthalmic applications make the Nd:YAG laser the most exciting tech nological advancement in medicine and surgery for the 1980s.

The endoscopic use of lasers in the treatment of gastrointestinal d~seases began within the last decade and has evolved rapidly. Work is now being done at more than 150 centers in Europe, the United States, Japan and the rest of the world. To date no publi cation has defined the state of the art. This text attempts to fill that void. To disseminate information about therapeutic laser endoscopy, an increasing number of short courses have been sponsored in the United States wherein the attendee hears didactic lectures, views video tapes, and in addition, has the opportunity to have a "hands-on" experience with endoscopic laser therapy in the animal labs. This book is an expansion of the material presented in one such course sponsored by The Cook County Hospital in Chicago, Illinois, in October, 1982. The course was organized by Peter Bright-Asare, M. D. , Chairman of Gastroenterology at the time of the course and chaired by Dr. Bright-Asare and myself. Some of the lectures from the course have been broadened and formalized. Other chapters were invited and added. Also included are group discussions about issues that are either controversial or undefined. Attempts were made to secure consensus opinion from experienced investigators in areas where no hard scientific experimental or clinical data exists. The contributors have a wide range of interest and expertise. Dr.

This book focuses on the design, development, and characterization of a compact magnetic laser scanner for microsurgical applications. In addition, it proposes a laser incision depth controller to be used in soft tissue microsurgeries. The use of laser scanners in soft tissue microsurgery results in high quality ablations with minimal thermal damage to surrounding tissue. However, current scanner technologies for microsurgery are limited to free-beam lasers, which require direct line-of-sight to the surgical site, from outside the patient. Developing compact laser micromanipulation systems is crucial to introducing laser-scanning capabilities in hard-to-reach surgical sites, e.g., vocal cords. In this book, the design and fabrication of a magnetically actuated endoscopic laser scanner have been shown, one that introduces high-speed laser scanning for high quality, non-contact tissue ablations in narrow workspaces. Static and dynamic characterization of the system, its teleoperation through a tablet device, and its control modelling for automated trajectory executions have been shown using a fabricated and assembled prototype. Following this, the book discusses how the laser position and velocity control capabilities of the scanner can be used to design a laser incision depth controller to assist surgeons during operations.