Dr.K.O.Paulose FRCS Consultant ENT Surgeon
The most widely used laser in ENT surgery is the carbon dioxide laser. Its main effect of precise cutting with an extremely fine zone of coagulation reduces bleeding after incision considerably. The CO2 laser is considered the “workhorse” of laser for ENT surgeons.
The CO2 laser emits continuous or pulsed infrared radiation which is highly absorbed in water. Since any soft tissue is composed mainly of water, tissue at the focal point of the laser beam is instantaneously vaporized, leaving behind a thin necrotic layer of tissue which assures hemostasis.
About Co2 Laser
The wavelength emitted by a CO2 laser is 10,600 nanometers (nm). This wavelength is in the far infrared spectrum and is invisible to the human eye. Water has extremely high absorption at this wavelength. A 30 micron thin layer of water will absorb 90% of CO2 laser radiation, and only 10% will pass through. Since 75-95% of soft tissue is composed of water, this wavelength is highly absorbed in soft tissue and therefore highly effective in vaporizing soft tissue, regardless of color. Tissue vaporization is instantaneous with very minimal surrounding thermal necrosis which aids in hemostasis.
The surgeon can control the extent by which the laser beam is absorbed into surrounding tissue, resulting in an extremely precise tissue incision. To minimize heat transfer to surrounding tissue and reduce collateral heat damage, the duration of laser beam on the tissue can be controlled usually less than 1 millisecond.
To allow precise positioning of the surgical laser beam, an additional red, low power laser diode beam is incorporated in the system so that both beams are coincident at the surgical site.
Patients will experience considerably less postoperative pain in almost every instance. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends typical to scalpel incisions. The CO2 laser seals nerve endings as it “cuts”, so your patient will likely require less anesthesia during the operation, and enjoy easier recuperation.
When an incision is made with a scalpel blade, blood vessels in the area are severed, and can ooze during and after the surgery. Traditionally this is controlled by clamping the torn vessels with hemostats, cauterizing the vessel using electro-surgery, or holding gauze sponges until the bleeding stops. All of these procedures take time, which means the surgery takes longer and there is more postoperative swelling. The laser seals small blood vessels as it cuts, reducing or completely eliminating the need for any other bleeding control measures. This means less time is required for the surgical procedure and, usually, reduced need for anesthesia
Whenever an incision is made in the tissue with either a scalpel blade or scissors, inflammation begins in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system, there is much less postoperative swelling. In addition, laser energy does not crush, tear, or bruise tissue since there is no physical contact with the tissue. Postoperative Recovery is faster and the patient experiences more comfort.
Since laser beam operates at a temperature of over 200 degrees Fahrenheit; it is highly effective at killing bacteria that have the potential to cause an infection. In fact, this is particularly important in areas in which it is difficult to prevent contamination of the surgical site. The CO2 laser sterilizes the infected area as it removes diseased tissue, leaving healthy tissue undamaged. Because the sterilization process is so effective, the use of antibiotics is substantially reduced.
With laser surgery, healing is rapid and there is less postoperative discomfort. Laser procedures provide reduced trauma and less invasive surgeries for patients, improve recovery time, and shorten time spent in the hospital. The laser allows destruction of diseased tissue while preserving normal tissue. Post surgical edema and scarring is also reduced.
Laser is Precise
The laser can remove diseased tissue without affecting surrounding healthy tissue. Not only does the blood-free cutting benefit the patient, it also provides a clear, dry surgical field for the surgeon. The lack of bleeding improves the surgeon’s visual control of the procedure because he can clearly see the different tissue layers. As a result, the surgeon is able to enhance surgical precision.
ENT Laser Surgery in Jubilee Hospital Trivandrum
Laser surgery is done in this hospital for ear nose and throat problems quite extensively.
Laser in snoring surgery:
Lasers have been is used in surgery for snoring and sleep apnea. This procedure is called laser assisted uvulopalatoplasty (LAUP).
Laser Nose Surgery:
Surgery of the Nose and Sinuses done with laser called laser Assisted Endoscopic Sinus Surgery or Endoscopic laser technology for ENT surgery. Laser is used to treat nasal allergy.LAPT.
Cosmetic Laser Surgery:
Cosmetic laser surgery is used to remove facial moles, tattoos and facial skin resurfacing to treat certain types of age-related changes in the skin
A laser beam can operate delicate tissues as it can be focused on a particular area. Laser surgery includes bloodless removal of a surface lesion, such as a tumor. It is useful in treating oral lesions like leukoplakia.
Laser Tonsil and Adenoid Surgery:
Tonsils and adenoids can be removed with laser more efficiently than in traditional surgery without causing any bleeding.
Laser Tongue Tie:
Laser release of tongue tie is the best and easy way for ankyloglossia. It can be done under local anesthesia.
Laser in Ear Surgery:
Laser Myringotomy (OTOLAM) is very easy procedure that can be done under local anesthesia.
Laser voice surgery:
Lasers are commonly used in the field of ENT for the work on the voice box. Lasers can be used to incise or remove parts of the voice box or for alteration of pitch of voice