CO2 laser

• CO2 laser is a mixture of carbon dioxide, nitrogen and helium with the CO2 as
the active, energy emitting gas.
• When an electric discharge occurs in the gas, the electrons collide with nitrogen
molecules and they are raised to excited states.
• Now N2 molecules in the excited state collide with CO2 atoms in ground state and
excite to higher state.
• The CO2 laser has a high conversion efficiency of the order of 15% as compared
with the ruby which has an efficiency of about 1–2%.
• It operates with a simple cooling system of tap water and is relatively inexpensive.
• The beam can be reflected or focused by appropriate mirrors and lenses, thus
lending itself to passage through a surgical manipulator.
• The normal operation of the laser is multimode.
• The operating microscope can be used in conjunction with the CO2 laser as an aid to
good visualization of tissues undergoing treatment.

• The laser head contains the CO2 laser which produces the invisible infrared (10.6
micron) beam used for surgery. A continuously adjustable power up to 25 W is available.

• A small helium-neon laser provides a visible red (0.8 mW, 6328 A) aiming beam.
This beam provides accurate visualization of the operating area for precise laser
removal of pathological tissue.
CO2 laser
• The CO2 laser provides a means of bloodless surgery. It causes a thin layer of heat
coagulated tissue immediately around the treatment site while the cells beyond this
site remain untouched, undisturbed and begin the healing process promptly.

• Post-operative oedema—experienced in cryosurgery (use of extreme cold

produced by liquid nitrogen or argon to destroy the abnormal tissue) and
diathermy—is minimal in laser surgery. As a result, healing is faster with a
minimum of tissue swelling and scarring and with less post-operative pain and
discomfort.

• The laser destroys tissue by vaporizing cells. Tissue, which contains 80-90%
water, when exposed to laser energy, is disrupted by steam formation within the
cells.
• CO2 laser has been extensively used for surgical applications.
• Characteristics: 1.high-power continuously operating laser
• 2.wavelength of operation is in the infrared region at 10.5 µm, -a wavelength that
is almost completely absorbed by most biological tissues.

• As a result, the laser beam can be focused to very small spot size, permit the
application of radiation to tissue in dosages sufficient to cause rapid burning and
vapourization of a well-localized volume of tissue.
APP:
• The most common applications of CO2 laser are in microsurgery, where the laser
beam is focused to be parfocal with the operating microscope.
• The coherent monochromatic beam can be exactly focused on an area
approximately 1 mm diameter and is controlled through the optical system
connected microscope.
• A very precise micro-manipulator directs the laser light to the treatment area.

• In general surgery, the laser can be directed through a surgical handpiece which
allows large or easily accessible areas to be treated efficiently. For areas that are
difficult or impossible to reach by conventional methods, the laser is used in
conjunction with an endoscope.
• In many diseases of the nose, oral cavity, nasopharynx and the tracheo-bronchial
tree, lasers have become the preferred surgical instrument. The laser is now
increasingly used as a primary treatment in selected cancers of the larnyx, pharynx
and oral cavity.
 APP:
• Laser surgery of larynx: Its precision, absence of bleeding, control of depth and area of
destruction, reduction of tissue reaction and preservation of normal tissue has extended
the quality of operative procedures.
• Gyneacology: Previous to laser surgery, the gynaecologist was forced to sacrifice large
areas of normal tissue in order to remove a little pathologic tissue.
With the laser surgery, small areas of tissue can be removed even in the most
inaccessible anatomic regions
rapid healing without scar formation
Outpatient basis

• The use of lasers offers the possibility of cutting bones without undesirable massive
destruction or dislocation, such as often cannot be avoided in classical surgical
techniques.
Limitations
1.the operative field must be dry; the presence of blood, cerebro-spinal fluid, saliva
would make it impossible to proceed with tissue destruction until they have been
removed.

2.Also, the target lesion must be clearly visible at all times. The lesion can be
viewed in a stainless steel mirror, if necessary and treated with laser but the mirror
must be kept free of smoke and steam.
Semiconductor lasers
• Semiconductor lasers are highly efficient laser light emitting devices which are
extremely small.

• semiconductor materials- the gallium arsenide/aluminum gallium arsenide system

and the indium phosphide/indium gallium arsenide phosphide system.

• The first semiconductor laser device were made from chips of gallium arsenide.
The gallium arsenide was grown such that p-n junction or diode was formed.

• Laser diodes which contain a medium (semiconductor material) are pumped

electrically and have a resonator.

• Rather than using mirrors, manufacturers employ the differences in the index of
refraction between semiconductor layers to form the resonator.
• The early devices suffered from a lack of coherence due to the wide spectral bandwidth
and low power output.

• Nowadays they can be mass produced with a comparable reliability as standard electronic
components.

• With this link in processing technology, electronic devices can be integrated with
semiconductor lasers

• The most commonly available semiconductor laser is made from AIGaAs material

• The laser diodes can be packaged individually or for greater power, can be packaged in
arrays.

• Most diode lasers are continuous wave, but there are also pulsed versions, depending on
the application.
• Laser diodes have been used in therapeutic applications and are being used as
pumps for solid-state lasers. They can be used with advantage as photo-
coagulators.
• They offer greatly decreased size, cost and reduced maintenance.
• treatment of retinal vascular disease.
• The technical disadvantages of the diode laser include limited power output and a
more divergent beam cone angle than the argon and krypton lasers.
Safety with lasers
• A serious problem in the use of lasers for surgical applications is that of ignition
• Precautions must be taken to avoid anaesthetic gases which are flammable or explosive.

• Oxygen must be handled by exercising reasonable care in using the laser.

• Laser dangers can include fires to unprotected drapes and endotracheal tubes, wherein
oxygen-enriched environments increase the chance of fire.

• Safe laser practices include wearing protective eyewear that is made for the wavelength
being used. This eyewear must be labelled for the wavelength and optical density. There
is a possibility that the laser beam could impinge on a flat metal surface and by chance, be
reflected as a focused beam.
• Therefore, the operating room personnel should wear glasses to protect their eyes. For the
same reason, the patient’s eyes should be protected by protective eyewear or wet towels
over the eyes.
Safety with lasers
• The facility must also have a committee in charge of laser safety, to ensure that all
safe laser practices are followed, and to monitor and enforce the control of laser
hazards.

• Laser safety standards have been worked out such as ANSI-Z136.1, American
National Standard for safe use of lasers, and ANSI-Z136.3, for the safe use of
lasers in health care facilities.

• These standards used together should be followed by any facility that has a laser
of any type.