'''Laser surgery''' is a type of [[surgery]] that uses a [[laser]] (in contrast to using a [[scalpel]]) to cut [[Tissue (biology)|tissue]].
'''Laser surgery''' is a type of [[surgery]] that uses a [[laser]] instead of a traditional [[scalpel]] to cut or remove [[tissue (biology)|tissue]]. It is widely used in various medical specialties due to its precision, minimal invasiveness, and reduced healing time.
Examples include the use of a laser scalpel in otherwise conventional surgery, and '''soft-tissue laser surgery''', in which the laser beam vaporizes [[soft tissue]] with high [[water]] content.
Laser surgery is commonly used on the [[human eye|eye]]. Techniques used include [[LASIK]], which is used to correct near and far-sightedness in vision, and [[photorefractive keratectomy]], a procedure which permanently reshapes the cornea using an [[excimer laser]] to remove a small amount of the human [[Tissue (biology)|tissue]].<ref>{{cite book|last=Cuscheri|title="Essential Surgical Practice". Basic surgical training.|edition=4|pages=62–65|display-authors=etal}}</ref><ref>{{cite book|last=Schwesinger|first=WH|author2=Hunter, JG |title=Laser in General Surgery|publisher=Surgical Clinics of North America|year=1992}}</ref><ref>{{cite book|last=Morris|first=Peter J|author2=Wood, William C. |title=Oxford Textbook of Surgery|volume=2}}</ref>
Types of surgical lasers include [[carbon dioxide]], [[argon]], [[Nd:YAG laser]], and [[potassium titanyl phosphate]], from among others.
== Effects ==
# [[Photochemistry|Photochemical effect]]: clinically referred to as photodynamic therapy. [[Photosensitizer]] (photophrin II) is administered which is taken up by the tumor tissue and later irradiated by laser light resulting in highly toxic substances with resultant necrosis of the tumor. Photodynamic therapy is used in palliation of oesophagial and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
# [[Refractive surgery|Photoablative effect]]: Used in eye surgeries like band keratoplast, and endartectomy of peripheral blood vessels.
# [[Photothermal therapy|Photothermal effect]]: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophagial varices
# [[Photomechanical effect]]: used in intraluminal lithotripsy
==Equipment==
[[File:Sharplan 40C.jpg|upright|thumb|right|300 px|A 40 watt CO<sub>2</sub> laser used for soft-tissue laser surgery]]
Surgical laser systems, sometimes called "laser scalpels", are differentiated not only by the wavelength, but also by the light delivery system: flexible fiber or articulated arm, as well as by other factors.<ref>{{Cite journal|last=Rosenlicht|first=J|last2=Vitruk|first2=P|date=2015|title=Ablation and sulcular debridement utilizing the CO2 laser for denture-induced gingival hyperplasia|url=https://www.implantpracticeus.com/clinical/oral-soft-tissue-laser-ablative-and-coagulative-efficiencies-spectra/|journal=Implant Practice US|volume=8|issue=2|pages=35–38|via=}}</ref>
CO<sub>2</sub> lasers were the dominant soft-tissue surgical lasers as of 2010.<ref name=":0">{{Cite book|url=https://books.google.com/books?id=C0weN_XdaiAC|title=Principles and Practice of Laser Dentistry - E-Book|last=Convissar|first=Robert A.|date=2010-05-19|publisher=Elsevier Health Sciences|isbn=978-0323079891|language=en}}</ref>
== Applications ==
===Soft tissue===
Soft-tissue laser surgery is used in a variety of applications in human ([[general surgery]], [[neurosurgery]], [[Otolaryngology|ENT]], [[dentistry]], [[orthodontics]],<ref>{{cite journal |vauthors=Borzabadi-Farahani A|title=The Adjunctive Soft-Tissue Diode Laser in Orthodontics|journal=Compend Contin Educ Dent.|volume=37|pages=e18–e31 |issue=eBook 5 |date= 2017 | pmid=28509563}}</ref> and [[oral and maxillofacial surgery]] as well as [[veterinary]]<ref name="BergerEeg2008">{{cite book|author1=Noel A. Berger|author2=Peter H. Eeg|title=Veterinary Laser Surgery: A Practical Guide|url=https://books.google.com/books?id=HinlPOuOS2MC|date=9 January 2008|publisher=John Wiley & Sons|isbn=978-0-470-34412-5}}</ref> surgical fields. The primary uses of lasers in soft tissue surgery is to cut, [[Laser ablation|ablate]], vaporize, and [[Coagulation|coagulate]]. There are several different laser wavelengths used in soft tissue surgery. Different laser wavelengths and device settings (such as pulse duration and power) produce different effects on the tissue. Some commonly used lasers types in soft tissue surgery include erbium, [[Laser diode|diode]], and CO<sub>2</sub>. Erbium lasers are excellent cutters, but provide minimal hemostasis. Diode lasers (hot tip) provide excellent hemostasis, but are slow cutters. CO<sub>2</sub> lasers are both efficient at cutting and coagulating.<ref>{{Cite book|chapter-url=https://books.google.com/books?id=FgRODgAAQBAJ&pg=PA349&lpg=PA349|title=Oral and Maxillofacial Surgery - E-Book: 3-Volume Set|last=Strauss|first=Robert|date=2017-03-08|publisher=Elsevier Health Sciences|isbn=9780323444422|editor-last=Fonseca|editor-first=Raymond J.|location=|pages=327–354|language=en|chapter=24}}</ref>
==== Dermatology and plastic surgery ====
A range of lasers such as erbium, dye, Q switch lasers and CO<sub>2</sub> are used to treat various skin conditions including scars, vascular and pigmented lesions, and for [[photorejuvenation]]. The laser surgery for dermatology often bypass the skin surface. The principle of laser surgery for dermatologic problem is based on SPTL (selective photothermolysis). The laser beam penetrates the skin until it encounters chromophore which absorbs the laser beam. After absorption of the laser beam, heat is generated to induce coagulation, necrosis of the targeted tissue, this results in removal of unwanted tissue by laser surgery.
[[Laser resurfacing]] is a technique in which [[covalent bond]]s of a material are dissolved by a laser, a technique invented by aesthetic plastic surgeon [[Thomas L. Roberts, III]] using [[Carbon dioxide laser|CO<sub>2</sub> lasers]] in the 1990s.<ref>Roberts, Thomas L III. The emerging role of the CO<sub>2</sub> laser in aesthetic plastic surgery. Presented at the XIII Congress of the International Society for Aesthetic Plastic Surgery, New York, NY, Sept. 28-Oct. 1, 1995.</ref><ref>{{cite journal|last=Roberts|first=Thomas L III |author2=Lettieri, John T |author3=Ellis, Laura B. |title=CO<sub>2</sub> Laser Resurfacing: Recognizing and Minimizing Complications|journal=Aesthetic Surgery Journal|publisher=American Society for Aesthetic Plastic Surgery|year=1996|pages=142–148|doi=10.1016/S1090-820X(96)70038-9 |volume=16}}</ref>
Lasers are also used for laser-assisted [[lipectomy]].<ref>{{cite journal|last1=Fakhouri|first1=TM|last2=El Tal|first2=AK|last3=Abrou|first3=AE|last4=Mehregan|first4=DA|last5=Barone|first5=F|title=Laser-assisted lipolysis: a review.|journal=Dermatologic Surgery |date=February 2012|volume=38|issue=2|pages=155–69|doi=10.1111/j.1524-4725.2011.02168.x|pmid=22093156}}</ref>
Laser surgery is commonly employed in ophthalmology, dermatology, dentistry, oncology, and vascular surgery. Different types of surgical lasers, such as [[carbon dioxide laser|CO₂ laser]], [[Nd:YAG laser]], [[argon laser]], and [[excimer laser]], are used based on the wavelength and intended medical application.
====Eye surgery====<!--Laser eye surgery redirects here-->
==Types of Laser Surgery==
Various types of laser surgery are used to treat [[refractive error]]. [[LASIK]], in which a knife is used to cut a flap in the [[cornea]], and a laser is used to reshape the layers underneath, is used to treat refractive error. [[IntraLASIK]] is a variant in which the flap is also cut with a laser. In [[photorefractive keratectomy]] (PRK, LASEK), the cornea is reshaped without first cutting a flap. In [[laser thermal keratoplasty]], a ring of concentric burns is made in the cornea, which cause its surface to steepen, allowing better near vision.
Laser surgery is categorized based on tissue interaction and medical application.
Lasers are also used to treat non-refractive conditions, such as [[phototherapeutic keratectomy]] (PTK) in which opacities and surface irregularities are removed from the cornea and [[laser coagulation]] in which a laser is used to cauterize blood vessels in the eye, to treat various conditions. Lasers can be used to repair tears in the [[retina]].
===Soft-Tissue Laser Surgery===
Soft-tissue laser surgery is used to cut, coagulate, vaporize, and ablate soft tissues with high [[water]] content. Common applications include:
* Otolaryngology (ENT surgery) – Treatment of polyps, tumors, and lesions in the [[larynx]] and [[nasal cavity]].
* Dentistry and Oral Surgery – Gingivectomy, [[frenectomy]], [[crown lengthening]], and treatment of periodontal disease.
* Dermatology – Used for scar removal, skin resurfacing, vascular lesions, and tattoo removal.
* Gynecology – Removal of uterine fibroids, endometriosis, and cervical dysplasia.
* Veterinary Surgery – Utilized for tumor removal and wound healing in animals.
==== Endovascular surgery ====
Effects of Laser on Soft Tissue
Laser [[endarterectomy]] is a technique in which an entire [[atheromatous plaque]] in the artery is excised. Other applications include laser assisted [[Angioplasty|angioplasties]] and laser assisted vascular [[anastomosis]].
Lasers interact with soft tissue through different mechanisms:
# [[Photochemical effect]] – Used in photodynamic therapy (PDT) to destroy cancerous or abnormal tissue.
# [[Photoablative effect]] – Used in refractive eye surgery, such as [[LASIK]] and [[photorefractive keratectomy (PRK)]].
# [[Photothermal effect]] – Used in endoscopic hemostasis, such as stopping bleeding from [[peptic ulcer disease]] or esophageal varices.
# [[Photomechanical effect]] – Used in lithotripsy to break down kidney or gallstones.
==== Foot and ankle surgery ====
===Hard-Tissue Laser Surgery===
Lasers are used to treat several disorders in [[foot and ankle surgery]]. They are used to remove benign and malignant tumors,<ref>{{cite encyclopedia |last=Garoufalis | first=Matthew G. |editor-first=Edward B. |editor-last=Ballow D.P.M. | date=February 1989 |title =Soft Tissue Lesions |encyclopedia=Laser Surgery of the Foot |publisher=International Society of Podiatric Laser Surgery | edition=First | pages=65–72 }}</ref> treat bunions,<ref>{{cite journal |last=Wynn D.P.M. |first=Michael H. |title=Soft-Tissue Bunion Repair with a CO2 Surgical Laser|journal=The Journal of Current Podiatric Medicine |volume=35 |issue=10 |date=October 1986 |pages=27–28}}</ref> debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and [[keloids]], and the removal of hypertrophic scars and tattoos.<ref>{{cite encyclopedia |last=Garoufalis | first=Matthew G. |editor-first=Edward B. |editor-last=Ballow D.P.M. | date=February 1989 |title =Soft Tissue Lesions |encyclopedia=Laser Surgery of the Foot |publisher=International Society of Podiatric Laser Surgery | edition=First | pages=65–72 }}</ref>
Hard-tissue lasers are used for cutting and reshaping bones and teeth, primarily in dentistry and orthopedics.
* Dentistry – Used for cavity preparation, root canal sterilization, and enamel etching.
* Orthopedic surgery – Used in bone sculpting, fracture healing, and spinal decompression.
A [[carbon dioxide laser]] (CO<sub>2</sub>) is used in surgery to treat [[onychocryptosis]] (ingrown nails), [[onychauxis]] (club nails), [[onychogryposis]] (rams horn nail), and [[onychomycosis]] (fungus nail).<ref>{{cite encyclopedia |last=Gorman| first=Jack B. |editor-first=Edward B. |editor-last=Ballow D.P.M. | date=February 1989 |title =Clinical Application of the Carbon Dioxide Laser to Podiatric Nail Pathologies: A Definitive Review of the Literature|encyclopedia=Laser Surgery of the Foot |publisher=International Society of Podiatric Laser Surgery | edition=First | pages=109–110 }}</ref>
==Common Types of Surgical Lasers==
Various types of lasers are used depending on wavelength and medical application:
* [[Carbon dioxide laser]] (CO₂ laser) – Used for skin resurfacing, tumor removal, and ENT surgery.
* [[Nd:YAG laser]] – Used in oncology, vascular surgery, and ophthalmology.
* [[Argon laser]] – Used in ophthalmology and dermatology.
* [[Excimer laser]] – Used in refractive eye surgery like [[LASIK]].
* [[Diode laser]] – Used in dentistry and dermatology.
==== Gastro-intestinal tract ====
==Applications of Laser Surgery==
# Peritoneum-Laser is used for [[adhesiolysis]].
Ophthalmology
# [[Peptic ulcer disease]] and [[oesophageal varices]] - Laser [[photoablation]] is done.
[[File:Lasik surgery.jpg|thumb|250px|LASIK surgery using an excimer laser.]]
# Coagulation of [[vascular malformation]]s of stomach, [[duodenum]] and [[Colon (anatomy)|colon]].
Laser surgery is extensively used in ophthalmology for treating refractive errors and retinal conditions:
# Lasers can be effectively used to treat early [[gastric cancer]]s provided they are less than 4 cm and without [[lymph node]] involvement. Lasers are also used in treating [[oral submucous fibrosis]].
* [[LASIK]] (Laser-Assisted In Situ Keratomileusis) – Reshapes the cornea to correct myopia, hyperopia, and astigmatism.
# Palliative laser therapy is given in advanced [[oesophageal cancer]]s with obstruction of [[Lumen (anatomy)|lumen]]. [[Recanalisation]] of the lumen is done which allows the patient to resume soft diet and maintain hydration.
* [[Photorefractive keratectomy (PRK)]] – Similar to LASIK but without creating a corneal flap.
# [[Laser ablation|Ablative laser]] therapy is used in advanced [[colorectal cancer]]s to relieve obstruction and to control bleeding.
* [[Phototherapeutic keratectomy (PTK)]] – Removes corneal opacities and irregularities.
# Laser surgery used in [[Hemorrhoid#Procedures|hemorrhoidectomy]], and is a relatively popular and non-invasive method of hemorrhoid removal.
* [[Laser coagulation]] – Used for treating diabetic retinopathy and retinal tears.
# Laser-assisted liver [[Segmental resection|resection]]s have been done using [[carbon dioxide laser|carbon dioxide]] and Nd:YAG lasers.
# Ablation of [[liver tumor]]s can be achieved by selective photovaporization of the tumor.
# [[Endoscopy|Endoscopic]] [[laser lithotripsy]] is a safer modality compared to [[electrohydraulic lithotripsy]].
==== Oral and dental surgery ====
Dermatology and Plastic Surgery
The CO<sub>2</sub> laser is used in oral and [[dental surgery]] for virtually all soft-tissue procedures, such as [[Gingivectomy|gingivectomies]], vestibuloplasties, [[Frenectomy|frenectomies]] and operculectomies.<ref>{{Cite journal|last=Kaplan|first=Martin|last2=Vitruk|first2=Peter|date=2015|title=Soft tissue 10,600 nm CO2 laser orthodontic procedures|url=https://lightscalpel.com/publications/soft-tissue-co2-laser-orthodontic-procedures/|journal=Orthodontic Practice US|volume=6|issue=6|pages=59–64|doi=|pmid=|access-date=}}</ref><ref>{{Cite journal|last=Levine|first=Robert|last2=Vitruk|first2=Peter|date=2015|title=Laser-Assisted Operculectomy|url=https://cced.cdeworld.com/courses/4953-Laser-Assisted_Operculectomy|journal=Compend Contin Educ Dent|volume=36|issue=8|pages=561–567|doi=|pmid=}}</ref> The CO<sub>2</sub> 10,600 nm wavelength is safe around [[Implantology|implants]] as it is reflected by titanium, and thus has been gaining popularity in the field of [[periodontology]]. The laser may also be effective in treating [[peri-implantitis]].<ref>{{Cite journal|last=Linden|first=Eric|last2=Vitruk|first2=Peter|date=2015|title=SuperPulse 10.6 µm CO2 laser-assisted, closed flap treatment of peri-implantitis|url=http://www.implantpracticeus.com/seeing-the-light/superpulse-10-6-%C2%B5m-co2-laser-assisted-closed-flap-treatment-of-peri-implantitis/|journal=Implant Practice US|volume=8|issue=4|pages=30–34|doi=|pmid=|access-date=}}</ref>
Laser surgery is widely used in dermatology for aesthetic and medical treatments:
* [[Laser resurfacing]] – Removes wrinkles, scars, and sun damage.
* Treatment of vascular lesions – Used for spider veins and port-wine stains.
* Tattoo removal – Uses Q-switched lasers to break down ink particles.
==== Spine surgery ====
Oncology
Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within [[discectomy]] to treat [[lumbar disc disease]] under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain.<ref>{{Cite journal|last=Quigley|first=M. R.|last2=Maroon|first2=J. C.|date=1994-01-01|title=Laser discectomy: a review|journal=Spine|volume=19|issue=1|pages=53–56|issn=0362-2436|pmid=8153804|doi=10.1097/00007632-199401000-00010}}</ref><ref>{{Cite journal|last=Ascher|first=P. W.|last2=Heppner|first2=F.|date=1984|title=CO2-Laser in neurosurgery|journal=Neurosurgical Review|volume=7|issue=2–3|pages=123–133|issn=0344-5607|pmid=6436735|doi=10.1007/bf01780695}}</ref>
Laser surgery is employed in cancer treatment, particularly for:
* Tumor ablation – Destroying cancerous tissues in the lungs, liver, and esophagus.
* Palliative care – Reducing tumor mass to alleviate symptoms in advanced cancer patients.
Since that time, laser spine surgery has become one of the most marketed forms of [[minimally invasive spine surgery]], despite the fact that it has never been studied in a controlled clinical trial to determine its effectiveness apart from disc decompression.<ref>{{Cite journal|last=Snyder|first=Laura A.|last2=O'Toole|first2=John|last3=Eichholz|first3=Kurt M.|last4=Perez-Cruet|first4=Mick J.|last5=Fessler|first5=Richard|date=2014|title=The Technological Development of Minimally Invasive Spine Surgery|journal=BioMed Research International|language=en|volume=2014|pages=293582|doi=10.1155/2014/293582|issn=2314-6133|pmc=4055392|pmid=24967347}}</ref><ref>{{Cite web|url=http://www.brainspinesurgery.com/the-truth-about-laser-spine-surgery/|title=The Truth About Laser Spine Surgery|last=Lim, MD|first=Jae Y.|date=|website=Atlantic Brain & Spine|access-date=}}</ref> Evidence-based data surrounding the use of lasers in spine surgery is limited and its safety and efficacy were poorly understood as of 2017.<ref>{{Cite web|url=https://www.spine.org/Portals/0/Documents/KnowYourBack/LaserSurgery.pdf|title=Lasers in Spine Surgery: A Review|last=Stern, MD, PhD, FACS|first=Jack|date=October 2009|website=www.Spine.org|access-date=}}</ref><ref>{{Cite web|url=https://providers.bcidaho.com/medical-management/medical-policies/sur/mp_70193.page|title=Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)|website=providers.bcidaho.com|access-date=2017-06-21}}</ref>
Vascular and Endovascular Surgery
Laser techniques are used for vascular conditions:
* Laser-assisted [[angioplasty]] – Helps open blocked arteries.
* Laser endarterectomy – Used to remove atherosclerotic plaque from arteries.
==== Thoracic surgery ====
Gastrointestinal Surgery
In [[thoracic surgery]], surgical laser applications are most often used for to remove pulmonary metastases and tumors of different primary localizations.<ref>Rolle A, Thetter O, Häussinger K. et al. Einsatz des Nd:YAG-Lasers in der Thoraxchirurgie. Herz Gefäß Thorax Chir 1989; 3:85-91</ref> Other areas of application are surgical sectioning of the parenchyma, anatomic segmental resections, removal of tumors from the thoracic wall<ref>Inderbitzi R, Rolle A. Palliative surgery for primary and secondary thoracic malignancies. Ther Umsch 2001 Jul;58(7) 435-41</ref> and abrasion of the pleura parietalis. Since the introduction of surgical lasers the amount of potentially surgically resectable pulmonary nodules has significantly increased.<ref>Rolle A, Pereszlenyi A, Koch R et al. Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm :YAG laser. J Thorac Cardiovasc Surg 2006; 131(6): 1236-1242</ref> Compared to laser surgery, other conventional surgical methods such as segmental or wedge resections with surgical stapling will normally lead to a bigger loss of lung tissue, especially in patients with multiple pulmonary nodules methods.<ref>Mineo TC, Cristino B, Ambrogi V et al. Usefulness of the Nd: YAG laser in parenchyma-sparing resection of pulmonary nodular lesions. Tumori 1994; 80(5):365-369</ref>
Laser surgery is applied in the treatment of:
* Gastrointestinal bleeding – Laser coagulation stops bleeding from peptic ulcers and esophageal varices.
* Laser-assisted hemorrhoidectomy – A minimally invasive alternative for hemorrhoid removal.
* Tumor ablation – Used for early-stage esophageal and colorectal cancers.
Other advantages of laser surgery compared to conventional methods are that it leads to an improved post operative lung function and that it gives the additional possibility to histologically analyze the removed material which would otherwise be destroyed through radiation or heat.
Dental Surgery
Lasers are used in soft and hard tissue dental procedures:
* [[Gingivectomy]] – Removal of excess gum tissue.
* [[Frenectomy]] – Correction of tongue-tie or lip-tie conditions.
* Cavity preparation – Laser drills can remove decayed enamel with minimal pain.
==== Other surgery ====
Neurosurgery
The CO<sub>2</sub> laser is also used in [[Gynaecology|gynecology]], [[genitourinary system|genitourinary]], [[general surgery]], [[otorhinolaryngology]], [[Orthopedic surgery|orthopedic]], and [[neurosurgery]].
Laser surgery is used in brain and spinal procedures:
* Laser spine surgery – Minimally invasive approach for herniated discs.
===Hard tissues===
==Advantages of Laser Surgery==
Lasers are used to cut or ablate [[bone]]s and [[teeth]] in [[dentistry]].<ref name="ColuzziConvissar2007">{{cite book|author1=Donald J. Coluzzi|author2=Robert A. Convissar|title=Atlas of Laser Applications in Dentistry|url=https://books.google.com/books?id=-jmjQAAACAAJ|year=2007|publisher=Quintessence Publishing Company|isbn=978-0-86715-476-4}}</ref>
Laser surgery offers several advantages over traditional surgical methods:
* Minimally invasive – Reduces tissue damage and scarring.
* Precision – Targets specific tissues with minimal impact on surrounding areas.
Laser surgery is a type of surgery that uses a laser instead of a traditional scalpel to cut or remove tissue. It is widely used in various medical specialties due to its precision, minimal invasiveness, and reduced healing time.
Laser surgery is commonly employed in ophthalmology, dermatology, dentistry, oncology, and vascular surgery. Different types of surgical lasers, such as CO₂ laser, Nd:YAG laser, argon laser, and excimer laser, are used based on the wavelength and intended medical application.
