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LasersLasers

A billion times brighter than sunlight, a laser beam has the power to penetrate diseased areas deep in the body with less pain, reduced risk of infection and faster recovery times than conventional surgery

Lasers are special types of light beams, powerful enough to cut through, vaporize and coagulate tissue. Most of the lasers used in medicine are created in gas-filled tubes on a principle similar to that used to create neon-type advertising signs or fluorescent strip lighting.

THE BENEFITS

The great advantage of lasers over the scalpel and needle is that surgery can be carried out under a local anaesthetic. Complicated operations can be performed in minutes rather than hours and recovery is measured in days rather than in weeks or months. Scarring is minimal and the surgeon doesn't have to cut through layers of flesh to reach the diseased area.

The use of lasers has led to new advances in keyhole surgery, where surgeons operate through a small puncture or through a small puncture or through an existing opening using telescopic fibre-optic tubes. It is estimated that, within the next few years, eight out of 10 of all operations will be performed using some kind of scope, allowing the surgeon to observe what he is doing on a television screen.

THE DANGERS

Laser treatment is also cheaper than conventional surgery, although the equipment is expensive to buy. However, it must only be performed by experienced surgeons. There's the ever-present danger that, in inexperienced hands, just a small slip could damage a vital organ or a blood vessel. At present, most doctors feel that laser treatment complements existing therapy rather than replacing it completely.

The many different applications of lasers in medicine depend on the fact that the beam can be precisely directed on a tiny area and on its ability to heat up the tissue without damaging a larger surrounding area. the advantages of laser surgery vary depending on the type of procedure and on the type of laser used. Where tissue is diseased, laser surgery tends to be less drastic and risky than using the scalpel or surgical knife.

GAS LASERS

The carbon dioxide laser is the most common type used in the operating theatre. Its beam, which is absorbed by water, acts like the perfect scalpel.

The argon laser (named after the gas used to produce the beam) specifically affects the red pigment in blood. This means that it can pass through tissues without causing damage and, when it encounters the blood vessels in the tissues, it coagulates or hardens them. This type of laser is used in abdominal and eye surgery, and to treat skin problems such as port wine stains.

SOLID LASERS

The yttrium aluminium garnet, or YAG, laser which was first developed for military purposes. this type of solid laser is particularly useful for treating advanced cancers and for penetrating parts of the body not easily reached by ordinary surgical techniques. It can travel down flexible tubes and its precision and high power make it useful for many operations.

Eye surgeons were the pioneers of lasers in surgery, particularly in their use as a treatment for the potentially serious eye problems that are often suffered by diabetics.

Argon lasers are most commonly used in eye surgery. The laser is shone through the lens of the eye, which has no blood vessels and so remains unharmed, on to the affected blood vessels at the back. These coagulate and the bleeding is stopped. Lasers have also been used to treat glaucoma - raised pressure in the eyeball - which can cause blindness.

CORRECTING SIGHT
Today, laser treatment is becoming common for treating short and long sightedness. In an operation that takes just 10 to 20 minutes, tissue is burned off the cornea - the transparent outer surface of the eye - so that it can focus correctly.

Nine out of 10 patients treated for shortsightedness can drive a car without glasses after treatment. However, some experts say that the technique hasn't been sufficiently researched and that the long-term consequences of this type of surgery haven't been evaluated.

INFERTILITY
The carbon dioxide laser is also used in laparoscopy, that is, viewing the reproductive organs through a telescope introduced into the abdomen. It is useful in treating endometriosis, clearing blocked Fallopian tubes and ovaries in cases of infertility and stemming abdominal bleeding.

Laser treatment can be used to cut out or vaporize cysts or fibroids, remove genital warts and treat pre-cancerous changes in the cells of the cervix - the neck of the womb. It has also been used as an alterative to hysterectomy for women suffering from heavy bleeding. Using a technique known as endometrial ablation, the surgeon lasers the lining of the womb, preventing it from sloughing off. However, the operation isn't always successful and fatalities have occurred where lasers were used by inexperienced hands. Studies are now being carried out to compare the procedure with conventional hysterectomy.

One of the most exciting potential applications of laser treatment is in surgery on unborn babies in the womb, for problems of the heart and blood vessels.

EAR, NOSE AND THROAT
The carbon dioxide laser has proved particularly useful for diseases affecting the larynx, such as removing polyps or other growths from the vocal cords, the nose or bronchi. It is also effective in the removal of the tonsils and the removal of pre-cancerous patches in the mouth or on the tongue.

Lasers have also been used to treat ear problems such as stapedectomy - the removal of a small bone in the middle ear which is implicated in otosclerosis, a condition which causes deafness. The degree of precision achieved by laser surgery and the minimal post-operative pain mean that many operations which once required a long stay in hospital can now be carried out on a day care basis.

NEUROSURGERY
The carbon dioxide laser has also proved invaluable in neurosurgery because of its precision. It has been used to destroy brain tumours, without the need for a large cut through the skull, and to remove meningiomas - tumours in the membranes surrounding the brain and spinal cord.

Patients with spinal tumours benefit from the no-touch technique of laser surgery because there is less risk of damage to the spinal cord and nerve roots. Lasers have also been used in spinal and disc surgery to treat chronic back pain.

MOLES AND BIRTHMARKS
Virtually scar-free pulsed dye and 'Q'-switched lasers have widely superseded the carbon dioxide and argon lasers originally employed by dermatologists.

Pulsed dye lasers can be used to remove blemishes such as port wine stains and broken veins or superficial pigmented marks, like some moles, while 'Q'-switched lasers are often best for tattoos and deeper pigmented blemishes.

Raised skin blemishes such as some skin cancers and various benign growths are still effectively eliminated by vaporizing them with a carbon dioxide laser.

Lasers are also employed in the gastroenterological ward, for example to staunch bleeding ulcers in the stomach and duodenum - the portion of intestine which is situated below the stomach.

In these cases, the laser is used together with a fibre-optic tube (endoscopy), allowing doctors to diagnose and treat at the same time. This flexible instrument can transmit light, for diagnosis, or a laser beam, for treatment. The tube is passed down into the body, under mild sedation, allowing the surgeon to view the ulcer. Then the laser beam can be used to clot the blood and stop the bleeding.

Lasers can also be used to break up gallstones and kidney stones. If necessary, the gall bladder can then be removed using an endoscope. Urologists - surgeons specializing in diseases of the urinary system - use lasers to treat small tumours of the bladder and of the prostate gland. These operations are quick to perform (many patients are treated as outpatients), and cause minimal damage to the organ concerned,

NEW TECHNIQUES
Elsewhere, lasers are being used to unblock clogged arteries, and to treat cancers of the bowel and bladder. Another technique is the use of YAG lasers to destroy tumours in solid organs, such as the liver, pancreas and breast.

However, such techniques are still being developed, though they show promise. So long as not too much heat is applied, the surrounding normal tissue is undamaged and the dead tumour can be left for the body's natural healing mechanism to remove.

     
     

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