Laser surgery

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Laser surgery
MeSH D053685

Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue.

Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content.

Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photorefractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of the human tissue.[1][2][3]

Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and Potassium titanyl phosphate, from among others.


  1. Photochemical effect: clinically referred to as photodynamic therapy. Photosensitizer (photophrin II) is administered which is taken up by the tumor tissue and later irradiated by laser light resulting in highly toxic substances with resultant necrosis of the tumor. Photodynamic therapy is used in palliation of oesophagial and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
  2. Photoablative effect: Used in eye surgeries like band keratoplast, and endartectomy of peripheral blood vessels.
  3. Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophagial varices
  4. Photomechanical effect: used in intraluminal lithotripsy


A 40 watt CO2 laser used for soft-tissue laser surgery

Surgical laser systems, sometimes called "laser scalpels", are differentiated not only by the wavelength, but also by the light delivery system: flexible fiber or articulated arm, as well as by other factors.[4]

CO2 lasers were the dominant soft-tissue surgical lasers as of 2010.[5]


Soft tissue[edit]

Soft-tissue laser surgery is used in a variety of applications in human (general surgery, neurosurgery, ENT, dentistry, orthodontics,[6] and oral and maxillofacial surgery[7]) as well as veterinary[8] surgical fields.

Dermatology and plastic surgery[edit]

A range of lasers such as erbium, dye, Q switch lasers and CO2 are used to treat various skin conditions including scars, vascular and pigmented lesions, and for photorejuvenation. The laser surgery for dermatology often bypass the skin surface, the principle of laser surgery for dermatologic problem is based on SPTL(selective photothermolysis). The laser beam penetrates the skin until it encounters chromophore which absorbs the laser beam, after absorption of the laser beam, heat is generated to induce coagulation, necrosis of the targeted tissue, this results in removal of unwanted tissue by laser surgery.

Laser resurfacing is a technique in which covalent bonds of a material are dissolved by a laser, a technique invented by aesthetic plastic surgeon Thomas L. Roberts, III using CO2 lasers in the 1990s.[9][10]

Lasers are also used for laser-assisted lipectomy.[11]

Eye surgery[edit]

Various types of laser surgery are used to treat refractive error:

  • LASIK, in which a knife is used to cut a flap in the cornea, and a laser is used to reshape the layers underneath, to treat refractive error
    • IntraLASIK, a variant in which the flap is also cut with a laser
  • Photorefractive keratectomy (PRK, LASEK), in which the cornea is reshaped without first cutting a flap
  • Laser thermal keratoplasty, in which a ring of concentric burns is made in the cornea, which cause its surface to steepen, allowing better near vision

Lasers are also used to treat non-refractive conditions, such as:

  • Phototherapeutic keratectomy (PTK), in which opacities and surface irregularities are removed from the cornea
  • Laser coagulation, in which a laser is used to cauterize blood vessels in the eye, to treat various conditions
  • Lasers can be used to repair tears in the retina.

Endovascular surgery[edit]

Laser endarterectomy is a technique in which an entire atheromatous plaque in the artery is excised. Laser recanalization of blocked arteries. other applications include laser assisted angioplasties and laser assisted vascular anastomosis.

Foot and ankle surgery[edit]

Lasers are used to treat several disorders in foot and ankle surgery, they are used to remove benign and malignant tumors,[12] treat bunions,[13] debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and keloids, and the removal of hypertrophic scars and tattoos.[14]

A carbon dioxide laser (CO2) is used in surgery to treat onychocryptosis (ingrown nails), onychauxis (club nails), onychogryposis (rams horn nail), and onychomycosis (fungus nail).[15]

Gastro-intestinal tract[edit]

  1. Peritoneum-Laser is used for adhesiolysis.
  2. Peptic ulcer disease and oesophageal varices - Laser photoablation is done.
  3. Coagulation of vascular malformations of stomach, duodenum and colon.
  4. Lasers can be effectively used to treat early gastric cancers provided they are less than 4 cm and without lymph node involvement. Lasers are also used in treating oral submucous fibrosis.
  5. Palliative laser therapy is given in advanced oesophageal cancers with obstruction of lumen. Recanalisation of the lumen is done which allows the patient to resume soft diet and maintain hydration.
  6. Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
  7. Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
  8. Laser-assisted liver resections have been done using carbon dioxide and Nd:YAG lasers.
  9. Ablation of liver tumors can be achieved by selective photovaporization of the tumor.
  10. Endoscopic laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.

Oral and dental surgery[edit]

The CO2 laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies.[16][17] The CO2 10,600 nm wavelength is safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. The laser may also be effective in treating peri-implantitis.[18]

Spine surgery[edit]

Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within discectomy to treat lumbar disc disease under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain.[19][20]

Since that time, laser spine surgery has become one of the most marketed forms of minimally invasive spine surgery, despite the fact that it has never been studied in a controlled clinical trial to determine its effectiveness apart from disc decompression.[21][22] Evidence-based data surrounding the use of lasers in spine surgery is limited and its safety and efficacy were poorly understood as of 2017.[23][24]

Other surgery[edit]

The CO2 laser is also used in gynecology, genitourinary, general and thoracic surgery, otorhinolaryngology, orthopedic, and neurosurgery.[25]

Hard tissues[edit]

Lasers are used to cut or ablate bones and teeth in dentistry.[26]


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  2. ^ Schwesinger, WH; Hunter, JG (1992). Laser in General Surgery. Surgical Clinics of North America. 
  3. ^ Morris, Peter J; Wood, William C. Oxford Textbook of Surgery. 2. 
  4. ^ Rosenlicht, J; Vitruk, P (2015). "Ablation and sulcular debridement utilizing the CO2 laser for denture-induced gingival hyperplasia". Implant Practice US. 8 (2): 35–38. 
  5. ^ Convissar, Robert A. (2010-05-19). Principles and Practice of Laser Dentistry - E-Book. Elsevier Health Sciences. ISBN 032307989X. 
  6. ^ Borzabadi-Farahani A (2017). "The Adjunctive Soft-Tissue Diode Laser in Orthodontics". Compend Contin Educ Dent. 37 (eBook 5): e18–e31. PMID 28509563. 
  7. ^ Andreas Moritz (2006). Oral Laser Application. Quintessence Publishing Company, Incorporated. ISBN 978-1-85097-150-4. 
  8. ^ Noel A. Berger; Peter H. Eeg (9 January 2008). Veterinary Laser Surgery: A Practical Guide. John Wiley & Sons. ISBN 978-0-470-34412-5. 
  9. ^ Roberts, Thomas L III. The emerging role of the CO2 laser in aesthetic plastic surgery. Presented at the XIII Congress of the International Society for Aesthetic Plastic Surgery, New York, NY, Sept. 28-Oct. 1, 1995.
  10. ^ Roberts, Thomas L III; Lettieri, John T; Ellis, Laura B. (1996). "CO2 Laser Resurfacing: Recognizing and Minimizing Complications". Aesthetic Surgery Journal. American Society for Aesthetic Plastic Surgery. 16: 142–148. doi:10.1016/S1090-820X(96)70038-9. 
  11. ^ Fakhouri, TM; El Tal, AK; Abrou, AE; Mehregan, DA; Barone, F (February 2012). "Laser-assisted lipolysis: a review". Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 38 (2): 155–69. doi:10.1111/j.1524-4725.2011.02168.x. PMID 22093156. 
  12. ^ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72. 
  13. ^ Wynn D.P.M., Michael H. (October 1986). "Soft-Tissue Bunion Repair with a CO2 Surgical Laser". The Journal of Current Podiatric Medicine. 35 (10): 27–28. 
  14. ^ Garoufalis, Matthew G. (February 1989). "Soft Tissue Lesions". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 65–72. 
  15. ^ Gorman, Jack B. (February 1989). "Clinical Application of the Carbon Dioxide Laser to Podiatric Nail Pathologies: A Definitive Review of the Literature". In Ballow D.P.M., Edward B. Laser Surgery of the Foot (First ed.). International Society of Podiatric Laser Surgery. pp. 109–110. 
  16. ^ Kaplan, Martin; Vitruk, Peter (2015). "Soft tissue 10,600 nm CO2 laser orthodontic procedures". Orthodontic Practice US. 6 (6): 59–64. 
  17. ^ Levine, Robert; Vitruk, Peter (2015). "Laser-Assisted Operculectomy". Compend Contin Educ Dent. 36 (8): 561–567. 
  18. ^ Linden, Eric; Vitruk, Peter (2015). "SuperPulse 10.6 µm CO2 laser-assisted, closed flap treatment of peri-implantitis". Implant Practice US. 8 (4): 30–34. 
  19. ^ Quigley, M. R.; Maroon, J. C. (1994-01-01). "Laser discectomy: a review". Spine. 19 (1): 53–56. doi:10.1097/00007632-199401000-00010. ISSN 0362-2436. PMID 8153804. 
  20. ^ Ascher, P. W.; Heppner, F. (1984). "CO2-Laser in neurosurgery". Neurosurgical Review. 7 (2–3): 123–133. doi:10.1007/bf01780695. ISSN 0344-5607. PMID 6436735. 
  21. ^ Snyder, Laura A.; O'Toole, John; Eichholz, Kurt M.; Perez-Cruet, Mick J.; Fessler, Richard (2014). "The Technological Development of Minimally Invasive Spine Surgery". BioMed Research International. 2014: 1–9. doi:10.1155/2014/293582. ISSN 2314-6133. PMC 4055392Freely accessible. PMID 24967347. 
  22. ^ Lim, MD, Jae Y. "The Truth About Laser Spine Surgery". Atlantic Brain & Spine. 
  23. ^ Stern, MD, PhD, FACS, Jack (October 2009). "Lasers in Spine Surgery: A Review" (PDF). 
  24. ^ "Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)". Retrieved 2017-06-21. 
  25. ^ "Laser Surgery". LightScalpel. 
  26. ^ Donald J. Coluzzi; Robert A. Convissar (2007). Atlas of Laser Applications in Dentistry. Quintessence Publishing Company. ISBN 978-0-86715-476-4.