Laser

Properties of an ideal laser for laryngeal surgery

1. Superficial tissue penetration with minimal collateral tissue injury

2. Ability to cut and coagulate
3. Deliverable through a flexible fiber that can be passed through a flexible endoscope
4. Hemostatic properties

 Lasers cause tissue effects by absorption of the light energy and conversion into heat
 Vaporization is produced by Boiling the intracellular water
 The thermal effect of the lazer induce cell contraction: when temp is raised above 60
degree protein is denaturated and this will produce contraction
 To decrease collateral thermal damage use Short pulse lazer setting
 The most important parameter for eye protection is lazer wave length

 Works via vaporizing intercellular water

 Since CO2 lazer is precise it is used in microlaryngeal surgery
 Used for epithelial laryngeal dx like recurrent respiratory papillomatosis
 Treatment of rhinophyma
 Transmit beam of light 10.6 micrometer ( invisible & requires aiming beam for surgical
application)
 Seals nerve endings: less pain
 Seal lymphatic vessels: reduce lymphatic spread of malignant tissue
 Can t be used in direct contact with tissue
 Can’t be transmitted via flexible fibers
 One complication is airway fire if the endotracheal tube is not protected or dehiscence

 Visible wavelength 0.5 micrometer

 Absorbed only by red color: Has affinity to the Hb = good for vascular lesions
 Biggest advancement of the argon over the co2 lazer is the beam can be transmitted via
fiberoptic cables
 But it works on 220 voltage energizer & opening cooling system= adaptor + cooling
system

 Invisible beam of light 1.06 micrometer Has the deepest thermal penetration (4mm)
 Excellent photocoagulater in case of hemorrhage:
Hereditary hemorrhagic telangiectasias
Hemangioma
YAG upon interaction with the tissue produce 3 zones:
1. Vaporization zone
2. Coagulation zone
3. Zone of cell death replaced by fibrous tissue

This is why YAG is used for palliation of the tumor in esophagus due to the low risk of
perforation

KTP can be used to reduce bleeding in nasal polyposis

Pulsed dye lazer:

Used in heredity hemorrhagic telengectazia