Surgical Lasers

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality.

This text was designed for the physicians, nurses, technical personnel, and staff members of medical facilities using lasers for surgical, therapeutic, and diagnostic purposes. The objective is to provide an understanding of the potential health and safety hazards associated with the use of medical laser systems and the precautions needed to use them safely. To do this, it is necessary to have an awareness of applicable standargs and regula tions that apply to laser use. This book is not intended as a substitute for the American National Standards Institute (ANSI) Z-136. 3, "Safe Use of Lasers in Health Care Facilities," but to facilitate its implementation as well as the implementation of the many other related regulations and guidelines that are pertinent. These other regulations include the Medical Device Amendments to the Food and Drug Act, the Federal Laser Product Performance Standards issued under the Radiation Control for Health and Safety Act, and applicable regulations of the Occupational Safety and Health Administration (OSHA). The text is organized to provide first an overview of laser hazards, laser surgical applications, and laser biological effects. General safety control measures and safety standards are then presented. Because laser tech nology is rapidly evolving, these general guidelines will allow safe use of new laser systems as they become available. Finally, specific safety guide lines and precautions are provided for specialized laser applications in the different health care specialties.

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.

In every area of human endeavor, technology has opened the door for new advancements to occur. Much of the progress in medicine over the last few years is due, in large part, to new technological tools made available to clinicians and researchers. Laser is an expanding technological discipline in medicine that will ultimately contribute to a broad and rapid expansion of both diagnostic and treatment procedures. Laser is to light what music is to noise. Those physicians who wish to be most successful in the application of this technology, to the benefit of their patient, will learn of the subtle interactions of light with tissue. No technology is good or bad in itself. It is only in the choices we make, in when and how to apply that technology, that it gains its moral value. The use of lasers in medicine has some very definite advantages in the surgical and medical treatment of a variety of disorders. At the same time we must all be careful to not perpetrate the myth of lasers in medicine. Vastly overstated claims of the value of 'laser surgery' have been held out to the general public, resulting in health care being sought on the basis of laser availability.

The first complete, "how to" guide to laser surgery of the head and neck! This comprehensive reference covers all aspects of the use of lasers in facial plastic surgery, from basic science to surgical techniques. Introductory chapters provide complete coverage of different laser systems, laser safety, and laser physics. The majority of the book is devoted to presenting the use of lasers in skin resurfacing, treatment of vascular lesions, hair removal, treatment of pigmented lesions and tattoos, and aesthetic surgery. Throughout, you'll find expert commentary from surgeons at the forefront of the field.

Lasers have a wide and growing range of applications in medicine. Lasers for Medical Applications summarises the wealth of recent research on the principles, technologies and application of lasers in diagnostics, therapy and surgery. Part one gives an overview of the use of lasers in medicine, key principles of lasers and radiation interactions with tissue. To understand the wide diversity and therefore the large possible choice of these devices for a specific diagnosis or treatment, the respective types of the laser (solid state, gas, dye, and semiconductor) are reviewed in part two. Part three describes diagnostic laser methods, for example optical coherence tomography, spectroscopy, optical biopsy, and time-resolved fluorescence polarization spectroscopy. Those methods help doctors to refine the scope of involvement of the particular body part or, for example, to specify the extent of a tumor. Part four concentrates on the therapeutic applications of laser radiation in particular branches of medicine, including ophthalmology, dermatology, cardiology, urology, gynecology, otorhinolaryngology (ORL), neurology, dentistry, orthopaedic surgery and cancer therapy, as well as laser coatings of implants. The final chapter includes the safety precautions with which the staff working with laser instruments must be familiar. With its distinguished editor and international team of contributors, this important book summarizes international achievements in the field of laser applications in medicine in the past 50 years. It provides a valuable contribution to laser medicine by outstanding experts in medicine and engineering. Describes the interaction of laser light with tissue Reviews every type of laser used in medicine: solid state, gas, dye and semiconductor Describes the use of lasers for diagnostics