Lasers in surgery

Saptarshi Bhattacharya Medical College Kolkata

Light amplification by stimulated emission of radiation

Visible spectrum

380nm 700nm

11000nm

Infrared spectrum microwaves Gamma Rays X-rays Ultraviolet rays

radiowaves

Production of laser beams

Lasing medium

Laser beam

power Totally reflecting mirror Partially reflecting mirror

Production of laser beams

Lasing medium Solid crystals eg ruby, semiconductor diodes eg gallium arsenide Gas CO2,helium, argon, metal vapours Liquid Rhodamine 6G in methanol

Production of laser beams

Atoms of lasing medium excited to higher energy level When more atoms in upper energy level some emit photons to return spontaneously to ground state Wavelength characteristic of lasing media These photons interact with other atoms to release more photons This is stimulated emission of radiation

Production of laser beams

Lasing medium

Laser beam

power Totally reflecting mirror Partially reflecting mirror

Production of laser beams

Photons reflected back and forth between two mirrors causing further stimulated emission of radiation Partially reflective mirror allows some of this to escape as LASER beam

Properties of lasers
Collimated beam Beam is parallel Enables high irradiance of tissues Monochromatic Spatial coherence of component waves (in phase)

Classification
Continuous wave Pulsed Multiple pulses of higher energy Q-switched Fast shutter between lasing medium and partially reflective mirror When shutter closed build up of light energy in chamber Release as giant high energy pulse when shutter open

p o w e r time
continuous pulsed Q switched

Laser type Helium/ Neon

Wavelength Output power 630 (red) 0.5-10 mW

Beam output CW

Class 1-4 1,2,3A,3B

Beam transport Fibreoptic or mirrors

Argon ion
Nd:YAG Carbon dioxide Dye lasers Excimer KTP Diomeddiode array array laser

490-510 (blue-green)
1060 (infrared) 10600 <400 to >700 200 (ultraviolet) 532 730

3-10 W
70 W 5-30 W 15 J 0.1 J 15 W

CW and Q-switched
CW and pulsed CW and Q-switched Pulsed Pulsed Q-switched

4
4 4 4 4 4 4

Fibreoptic
Fibreoptic Mirrors Fibreoptic Direct Fibreoptic Fibreoptic

Medical applications
Therapeutic effects Stimulation of healing Diagnosis Optical alignment

Therapeutic effects
Photochemical effect Photothermal effect Photoablative effect Photomechanical effect

Photochemical effect
Administration of photosensitiser (hematoporphyrin derivative) Taken up and retained by dysplastic tissue or tumour Irradiated by appropriate laser light Production of toxic reactive species Necrosis of tumour

Photochemical effect
PDT used in inoperable esophageal and bronchial cancer, ablation of mucosal cancer of GIT and urinary bladder, in destruction of Barrets mucosa Prolonged time for clearance of photosensitisers and so prolonged avoidance of sunlight

Photothermal effect
Photocoagulation, cutting and ablation by vaporization CO2 laser penetration 0.2 mm Ideal for cutting and vaporisation of tissues Argon laser 0.5 mm penetration Used in ophthalmology and in photocoagulation

Photothermal effect
Nd:YAG 2mm penetration Used in endoscopic control of bleeding and in situ ablation of tumours of solid organs Pulsed dye lasers for treatment of port wine stains

Photoablative effect
Excimer lasers argon flouride, xenon chloride Ultraviolate range Use in ophthalmology for controlled precise ablation eg. Band keratoplasty, LASIK etc Remove atherosclerotic plaques from peripheral blood vessels

Photomechanical effects
Giant pulse laser energy Q-switched Nd:YAG laser, Holmium:YAG laser, Pulsed dye laser systems Produce localized shock waves Used for intraluminal lithotripsy, capsulotomy etc.

Medical applications
Therapeutic effects Stimulation of healing Diagnosis Optical alignment

Stimulation of healing
Low power, red or infrared spectrum Helium- neon, gallium arsenide Stimulate healing in soft tissue trauma, wound healing Relief of chronic musculoskeletal pain

Medical applications
Therapeutic effects Stimulation of healing Diagnosis Optical alignment

Diagnosis
Flourescent endoscopy Administration of ALA Converted to protoporphyrin IX Flouresces pink when irradiated with violet light Early diagnosis of severe dysplasia and in situ cancer of GIT, bronchus and urinary tract

Diagnosis
Laser Doppler velocimeters HeNe or diode lasers Measure skin blood flow, blood pressure, oxygen saturation (pulse oximeters)

Medical applications
Therapeutic effects Stimulation of healing Diagnosis Optical alignment

Optical alignment
Low powered lasers are used for patient positioning in radiotherapy and as light guide for invisible lasers

Technology is only as good as the hand using it

Thank you