Lumenis Smart CO2 Laser Solutions

for Minimally Invasive

Gynecological Surgery

Benefits of CO2 Laser in

Minimally Invasive Gynecology

Clinical Applications of CO2

Energy in Gynecological Surgery

During surgery, the unique, high-precision

characteristics of the CO2 laser translate to:

Endometriosis: 1, 2, 3, 4

Greater safety

Depth of cutting and tissue ablation is controllable

and predictable
Superficial effect with bare minimum of thermal damage
Reduced risk of complications, such as strictures
and adhesions

Higher precision

Low thermal impact (compared with electrocautery) for

minimal tissue disturbance
Excellent tissue visualization of surgical plane for
precision ablation, excision, and incisions

CO2 laser laparoscopic endometriosis surgery has been

shown to be associated with:
Less pain
Limited thermal damage
Low perioperative morbidity (e.g. blood loss, bladder
and bowel injury)
Significant improvements in quality of life
High fertility rates
Low recurrent disease rates

Adhesions: 5

Precise, yet hemostatic lysis of adhesions

Minimal thermal damage allows avoidance of injury to
neighboring structures

Myomas: 6, 7

Precision allows removal of pathological tissue, while

operating in well-defined surgical planes
Faster tissue healing is reflected by low rates of
adhesion formation

Smart CO2 Solutions for Laparoscopic Gynecological Surgery

Two handpieces are designed to facilitate surgeon technique

preference, through a trocar cannula or the suction irrigator,
for optimal maneuverability and access to the most difficult to
reach disease.

Greater power with less beam divergence

allows for maximal precision
Spot
diameter

Spot
diameter

Lumenis

For freebeam delivery, the SurgiTouch scanner and operating

system has become an industry benchmark for precision in
CO2 laser surgery, assuring reproducible tissue-effects that can
be perfectly tailored to patient anatomy. Beam alignment units
connect to commonly available operating laparoscopes.
For fiber delivery, advanced CO2 fiber technology used either in
robotic surgery or with specially designed GYN Laparoscopic
handpieces, feature consistent, high energy transmission and
a fiber tip that can be renewed during a procedure. This helps
assure predicable results, fast procedure times, and cost
effective procedures.

Quality Beam Performance

Other*

When it comes to delicate laparoscopic surgeries, optimal

thermal control and precision are required for smart tissue
management. With unique pulsed and continuous power
mode settings, you have optimal control over cutting, ablation,
or adequate hemostasis with the least amount of disturbance
to adjacent tissue. A clearly visible aiming beam helps you
target only the tissue of interest.
Lumenis provides the opportunity to choose either fiber or
freebeam delivery of precision CO2 laser energy depending on
your preference.

320

295

0mm

400

349

1mm

485

404

2mm

570

458

3mm

1153

839

10mm

1570

1111

15mm

This information relates only to fiber energy delivery.

* Other fiber manufacturers reported beam divergence numbers

CO2 Laser Energy as Compared with Other Energy Sources

(Monopolar, High-Power (7/10

Traditionally, minimally invasive laparoscopic surgery has

been performed with alternative energy sources such
as electocautery, harmonic scalpel, or even other laser
wavelengths. However, electrocautery-based treatment
of such disorders poses a tremendous surgical challenge.
In many cases pathology is located in close proximity to
important intra-abdominal structures such as the bowel,
ureters, urinary bladder and major blood vessels for which
thermal damage to non-target tissue should be avoided.

FiberLase, Super Pulse, 10W

Up to 600m
Thermal
Damage

A comparative study assessing the macro and

microscopic characteristics of the most commonly used
energy sources applied on the ureter, bladder and bowel
in a laparoscopic setting (in-vivo porcine model) showed
that CO2 laser energy was associated with the least deep
tissue damage. 8

No more
than 200m
Thermal
Damage

Monopolar, High-Power (7/10) FiberLase, SuperPulse, 10W

For similar cutting effects, the thermal damage associated

with electrocautery or other energy based tools can be
substantially higher than that of CO2 Laser.
Based on Lumenis internal testing.

Other Energy Sources Used in Minimally Invasive Laparoscopic Surgery8

Injury to
Mucosal
Surface of:

Energy Source Applied on External/Serosal Surface

Bipolar
Cautery

Monopolar
Cautery

Ultrasonic
Scalpel

CO2
Laser

Ureter

5/6

5/6

4/6

0/6

Bladder

2/3

1/3

0/3

0/3

Rectum

2/3

3/3

1/3

0/3

How is CO2 Laser Energy Delivered to the Abdominal Cavity?

Required accessory
Power delivery modes
Aiming beam
Properties

Free Beam

Fiber

MicroSlad, ColpoSlad,
Nezhat Adapter
Beam Align Units

Robotic Drop in Guide

CO2 fiber with GYN LAP handpieces

Continuous Wave, SuperPulse, Pulser

5 mW red diode laser, 635 nm, adjustable intensity
Confocal with optics
No additional hand required to
utilize energy source
For operation with common
colposcopes or laparoscopes
depending on application

Operated through a side-port (may

be inserted through the suction
irrigator)
May be more intuitive for surgeons
previously using electrocautery
May reach places which are not
under direct line of sight

What Do Physicians Say?

When it comes to fertility surgery, we have to work
around very delicate tissue and spare as much
healthy tissue as possible. Few tools offer precision
of the CO2 laser to help me excise only the tissue
of interest and perform extremely meticulous
dissections. Its a staple in my practice; I use it in
every operative case that I perform.
Ken Sinervo, M.D., Medical Director of the Center for
Endometriosis Care, Atlanta, Georgia, USA.

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Beam-Align direct laparoscope coupler

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References:
1. Sutton C, Hill D. Laser laparoscopy in the treatment of endometriosis: A 5-year study. BJOG 1990; 97:181-185
2. Meuleman C et al, Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet
Gynecol., 2012 Aug;24(4):245-52
3. Nezhat C et al, Laparoscopic Management of Bowel Endometriosis: Predictors of Severe Disease and Recurrence. JSLS 2011;15:431438
4. Schipper, E, Nezhat C; Video-assisted laparoscopy for the detection and diagnosis of endometriosis: safety, reliability and invasiveness; International Journal
of Womens Health 2012:4, 383 393
5. Albee R. Excision of Endometriosis with the Carbon Dioxide Laser; in Surgical Management of Endometriosis, Edited by David Redwine, Publ. Martin Dunitz, 2004
6. Starks GC. CO2 laser myomectomy in an infertile population. J Reprod Med. 1988;33(2):184-6
7. McLaughlin DS. Micro-laser myomectomy technique to enhance reproductive potential: a preliminary report. Lasers Surg Med. 1982;2(2):107-27.
8. Tulikangas PK, Smith T, Falcone T et al, Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril,
2001;75(4):806-810
9. R. Rox Anderson: Laser-Tissue Interaction; chapter in Cutaneous Laser Surgery: Goldman M, Fitzpatrick R; Mosby 1994
10. Kathryn M. Van Abel et. al.; Transoral Robotic Surgery Using the Thulium: YAG Laser; Arch Otolaryngol Head Neck Surg/Vol 138 (No.2), Feb 2012
11. Marc Remacle et. al.; Current State of Scanning Micromanipulator Applications With the Carbon Dioxide Laser; Annals of Otology, Rhinology & Laryngology
117(4): 239-244
12. Nezhat C and Nezhat F, Laparoscopic surgery with a new tuned high-energy pulsed CO2 laser. J Gynecol Surg, 1992;8(4):251-255
13. Meuleman C et al, Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic
segmental bowel resection and reanastomosis. Hum Reprod 2011;26(9):2336-43
14. Meuleman C et al, Clinical Outcome After Radical Excision of Moderate-Severe Endometriosis With or Without Bowel Resection and Reanastomosis: A
Prospective Cohort Study. Ann Surg. 2013 Apr 10.
15. Sutton C, Macdonald R. Laser Laparoscopic Adhesiolysis. J Gynecol Surg. Fall 1990, 6(3): 155-159.
2013, the Lumenis Group of Companies. All rights reserved. Lumenis, its logo, FiberLase, GYN LAP-R, GYN LAP-S are trademarks or registered
trademarks of the Lumenis Group of Companies. Specifications are subject to change without notice.
PB-1002670 Rev. A

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