General Surgery

How are lasers and energy-based devices used in general surgery?

Any surgical procedure can be performed using lasers. General surgeons use a variety of laser wavelengths and laser delivery systems to cut, coagulate, vaporize, or remove tissue. The majority of "laser surgeries" actually use the laser device in place of other tools such as scalpels, electrosurgical units, cryosurgery probes, or microwave devices to accomplish a standard procedure like mastectomy (i.e., breast surgery) or cholecystectomy (i.e., surgical removal of the gallbladder). They are useful in both open and laparoscopic procedures. Common surgical uses include breast surgery, removal of the gallbladder, hernia repair, bowel resection, hemorrhoidectomy, solid organ surgery, and treatment of pilonidal cysts.

Common uses for surgical lasers include:

• Neurosurgery, with precision cutting and endoscopic guidance in the brain and spinal cord
  
• Urology treatment of urinary stones, bladder obstructions, and enlarged prostates
  
• Dental applications such as drilling cavities, gum surgery, antibacterial treatments, and tooth decay detection with optical coherence technology OCT imaging
• Gastroenterology, for management of obstructing and bleeding tumors and vascular malformations
  
• Gynecology, for treatment of cysts, endometriosis, and fibroid tumors
  
• Otolaryngology, for treatment of lesions of the nasal passages, paranasal sinuses, larynx, and trachea
  

Benefits of lasers and energy-based devices in general surgery

Lasers allow the surgeon to accomplish more complex tasks, reduce blood loss, decrease postoperative discomfort, reduce the chance of wound infection, decrease the spread of some cancers, minimize the extent of surgery in selected circumstances and result in better wound healing, if they are used appropriately by a skilled and properly trained surgeon.

Recent advances in lasers and energy-based devices in general surgery

Some of the most exciting advances for lasers and energy-based devices have taken place in the area of cancer treatment. Applications include the use of these devices for tumor resection or ablation as well as in combination with drugs for photodynamic therapy, and interstitial thermotherapy. During Laser-induced interstitial thermotherapy (LITT), laser light at the tip of an optical fiber raises the temperature of the tumor cells and damages or destroys them. The FDA cleared an LITT device for use in neurosurgery in 2009.

reviewed may 20, 2016